Pediatrics: Pediatric Pulmonary |

A Comparison of High Frequency Chest Wall Oscillation and MetaNeb System for Airway Clearance in Tracheostomy Dependant Pediatric Patients FREE TO VIEW

Aneela Bidiwala, MD; Linda Volpe, MD; Claudia Halaby, MD; Melissa Fazzari, PhD; Christina Valsamis, MD; Melodi Pirzada, MD
Author and Funding Information

Winthrop University Medical Hospital, Albertson, NY

Copyright 2016, American College of Chest Physicians. All Rights Reserved.

Chest. 2016;150(4_S):963A. doi:10.1016/j.chest.2016.08.1066
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SESSION TITLE: Pediatric Pulmonary

SESSION TYPE: Original Investigation Slide

PRESENTED ON: Tuesday, October 25, 2016 at 02:45 PM - 04:15 PM

PURPOSE: The management of pulmonary complications of patients with chronic debilitation conditions such as cerebral palsy and neuromuscular disease requiring chronic care focuses on the enhancement of mucuciliary clearance to minimize infections and atelectasis. The aim of this study was to compare two modes of airway clearance, the MetaNeb system and high frequency chest wall oscillation system via VEST therapy in medically complex, pediatric patients with tracheostomy requiring long term care.

METHODS: This was a single center, retrospective study comparing the number of respiratory illnesses, pneumonias or tracheitis, utilization of bronchodilator and systemic steroids, and number of respiratory illnesses requiring acute care facility hospitalizations. A total of 8 tracheostomy patients between the ages of 1-22 years with chronic illnesses and with a tracheostomy tube were included for a 2 year study period. A Poisson regression model and generalized estimating equations were used to compare pre and post rates and to account for the correlation of count data from the same individual. Additionally, the paired differences (post - pre) for each event count were computed to provide the median and range of reductions in event rates while using MetaNeb and the non-parametric Wilcoxon signed-rank test employed to determine whether the results from the Poisson model were consistently observed regardless of method of analysis.

RESULTS: The total number of respiratory illnesses were reduced from 32 per year on VEST Therapy to 15 per year on MetaNeb (p<0.001). The total number of pneumonias were decreased from 15 per year to 6 per year (p=0.01), use of bronchodilator treatments were reduced from 53 to 21 (p<0.001) and utilization of systemic steroids were reduced from 12 to 4 during the MetaNeb therapy (p=0.003). Numbers of hospitalizations to acute care facilities were reduced from 8 to 3 hospitalizations during the use of MetaNeb therapy (p=0.003).

CONCLUSIONS: This study provides evidence that MetaNeb use over one year was superior to VEST therapy in providing airway clearance. However our study was limited due to small sample size. We recommend further large high quality, randomized controlled studies to demonstrate validity and long term outcome.

CLINICAL IMPLICATIONS: Pulmonary complications can be life threatening in patients who have chronic debilitating diseases. Utilizing more effective way of airway clearance with new modalities such as MetaNeb can reduce morbidity and mortality in tracheostomy dependent patients.

DISCLOSURE: The following authors have nothing to disclose: Aneela Bidiwala, Linda Volpe, Claudia Halaby, Melissa Fazzari, Christina Valsamis, Melodi Pirzada

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