Positive expiratory pressure (PEP) treatment in children with multiple severe disabilities.

Children with multiple severe disabilities cannot be spontaneously physically active and therefore lack the ventilatory stimulation of physical activity. They often produce large quantities of airway mucus, which they have difficulty to evacuate on their own. The accumulation of mucus may lead to respiratory insufficiency.To investigate whether chest physiotherapy with positive expiratory pressure (PEP) could improve the blood oxygen tension (PO(2)) and/or decrease carbon dioxide tension (PCO(2)) in severely disabled children with airway mucus accumulation.Eighteen disabled children (mean age 7.5 y, SD 4.3, range 1.7-17.8 y) participated in the study. Transcutaneous (tc) PO(2), tcPCO(2) and respiratory rate (RR) were recorded before and after PEP treatment. The reproducibility of the effect of the treatment was tested by repeating the recordings.The mean tcPO(2) increased 1.0 kPa (range -0.2 to 3.4 kPa) immediately after PEP treatment (p=0.0001). No significant changes in tcPCO(2) or RR were noted. The reproducibility of the effect of PEP treatment was good, with a significant increase in tcPO(2) at all retests. All children accepted the treatment well.PEP increases blood oxygen tension immediately after treatment in severely disabled children with airway mucus accumulation. Long-term effects remain to be proven.