Positive expiratory pressure (PEP) therapy. What pressures do we achieve in young children with cystic fibrosis? A single-centre study

This study was a clinical review of infant positive expiratory pressure (PEP) therapy in young children with cystic fibrosis (CF). The aim of this study was to determine whether pressures of 10–20 cm H2O PEP therapy (recommended by the CF trust) are being achieved with routine airway clearance therapy. This took place at the Royal Hospital for Children, Glasgow a specialist UK CF centre. Values were obtained from 21 young children. Pressures above 10 cm H2O during tidal volume breathing were not achieved within our cohort. Further investigation is required to determine efficacy of lower pressures in PEP therapy with young children.

Emergency Pediatric Noninvasive Ventilation and Invasive Mechanical Ventilation

Respiratory complaints are common conditions for children to present to emergency departments. Typically, patients respond to simple supportive treatment, whether it is airway clearance therapy, oxygen therapy, or bronchodilators. When these patients are critically ill, they often require aggressive oxygenation/ventilation with noninvasive strategies, or even tracheal intubation. The use of noninvasive positive pressure ventilation has led to a significant reduction in the necessity for endotracheal intubation in children. The emergency physician should be familiar with the indications and appropriate application of these modalities. Furthermore, when patients require invasive mechanical ventilation, the emergency physician should have an understanding of initial ventilator settings, troubleshooting alarms, and an approach to the decompensating pediatric ventilated patient.