Zaporožskij Medicinskij Žurnal (Jun 2020)
Evaluation and selection of high-frequency chest wall oscillation modes in children with community-acquired pneumonia based on pulse oximetry
Abstract
The high-frequency chest wall oscillation (HFCWO) is a method of airway clearance therapy, which helps to restore the drainage function of the bronchial glands, improve the pulmonary function and pulmonary gas exchange in children with cystic fibrosis, atelectasis, and bronchiectasis. Aim: to select effective modes of high-frequency chest wall oscillation for increase oxygen saturation in children with community-acquired pneumonia based on pulse oximetry data. Materials and methods. The selection and evaluation of the HFCWO modes were performed in 261 children (girls – 47.1 % and boys – 52.9 %) aged 6–17 years with a moderate degree and acute course of community-acquired pneumonia (CAP) using eight oscillation modes of the Vest Airway Clearance System, Model 105. The effectiveness of the HFCWO modes was assessed on the 1st and 10th day of the disease by measuring the degree of arterial hemoglobin oxygen saturation (SpO2) using noninvasive transmission pulse oximetry with the use of a pulse oximeter, Series YX 300. The ROC analysis was performed, the area under the ROC curve (AUC) was presented with the associated 95 % confidence interval (CI). Results. According to a comparison of the sensitivity and specificity of the ROC analysis method, the 1st mode of HFCWO is recommended to apply for preschool children of asthenic somatotype, which is confirmed by the highest AUC – 0.95 (95 % CI 0.86–1.00). The 2d mode of HFCWO should be included in the complex therapy for preschool children of normosthenic somatotype, which is confirmed by the highest AUC – 0.94 (95 % CI 0.88–1.00). For prepubertal children of asthenic somatotype the 3rd mode of HFCWO should be used based on the highest value of AUC – 0.93 (95 % CI 0.81–1.00). For prepubertal children of normosthenic somatotype, we recommend including the 4th mode of HFCWO with an AUC value of 0.94 (95 % CI 0.84–1.00) in the comprehensive treatment of CAP. Regarding the adolescents of asthenic somatotype, we recommend applying the 5th mode of HFCWO, the AUC of which is 0.97 (95 % CI 0.91–1.00). As for the adolescents of normosthenic somatotype, the 6th mode of HFCWO should be used based on the AUC– 0.98 (95 % CI 0.91–1.00). Conclusions. To increase the effectiveness of community-acquired pneumonia treatment, it is necessary to include HFCWO in the daily therapy taking into account the optimal oscillation parameters. Modes 1-6 of HFCWO influence the level of oxygen saturation, improving it. It is recommended to use sparing oscillation modes (1, 3 and 5) for children with asthenic somatotype in complex therapy of pneumonia compared to children with normosthenic somatotype.
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