Reduction in respiratory exacerbation rate in patients with severe bilateral cerebral palsy following daily PEP-mask therapy: a retrospective study

Chiara Di Pede, Elena Colombo, Miriam Duso, Davide Conte, Vittoria Marcon, Andrea Vianello, Stefano Masiero, Andrea Martinuzzi

Research output: Contribution to journalArticlepeer-review


BACKGROUND: Respiratory complications caused by the inability to protect the upper airways and ineffective cough represent a major cause of morbidity and mortality in patients with cerebral palsy (CP). Even though the application of Positive End-Expiratory Pressure (PEP) through a face mask has gained large popularity as a technique to prevent bronchial mucous encumbrance, its long term effects on clinical course and respiratory function in individuals with CP have not been investigated.

AIM: To investigate whether regular application of PEP through a face mask can improve clinical status and respiratory function in patients with severe CP.

DESIGN: Observational, retrospective cohort study.

SETTING: The outpatient rehabilitation unit of the IRCCS E. Medea Rehabilitation Hospital -Conegliano, Italy.

POPULATION: CP outpatients admitted to the unit between January 1, 2006 and December 31, 2018.

METHODS: All the medical records of the enrolled patients were collected and reviewed. All patients underwent multidisciplinary respiratory evaluation at T0 (immediately before the beginning of PEP-use) and T1 (12 months after). The evaluation assessed respiratory infections history (number of exacerbations per year), blood gas analysis, measurement of airway resistance through the interrupter technique.

STATISTICAL ANALYSIS: Descriptive statistics was applied for data analysis employing SPSS 16.0 software for Windows.

RESULTS: Twenty-one patients affected with CP (mean age 9,19 years, SD 5,56, range 3-23, 8 females) were included. All patients had more than 3 infections per year (mean 4,81, SD 1,17) in the year prior to treatment (T0). At T1 mean number of infections was 1,57 (SD 0,81); 17 patients (80%) reported less than three infections; two patients (10%) reported zero infections, two patients (10 %) reported three infections. Blood gas analysis and airway resistance values did not show a significant difference at T0 and T1.

CONCLUSIONS: Daily PEP-mask therapy reduces frequency of respiratory exacerbations in patients with severe bilateral CP.

CLINICAL REHABILITATION IMPACT: PEP-mask is a valuable rehabilitative tool in severe CP patients with frequent respiratory exacerbations.

Original languageEnglish
JournalEuropean Journal of Physical and Rehabilitation Medicine
Publication statusE-pub ahead of print - Sep 4 2019


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