Comparison of the efficacy of supine and prone position ventilation combined with high-frequency chest wall oscillation expectoration and ultrashort wave physiotherapy in children with severe pneumonia

Objective To investigate the effects of supine and prone position ventilation combined with high-frequency chest wall oscillation expectoration (HFCWO) and lung ultrashort wave physiotherapy(SW) on the improvement of oxygenation indexes, sputum characteristics, serum cytokines and clinical symptoms in children with severe pneumonia.

Methods Sixty children with severe pneumonia treated with mechanically ventilation were randomly divided into the supine position ventilation(SP) group, SP+SW group, prone position ventilation(PP) group and PP+SW group(15 cases each group).The alveolar arterial oxygen differential pressure, blood oxygen partial pressure, carbon dioxide partial pressure, pulse blood oxygen saturation, oxygenation index, sputum viscosity and sputum volume in airway, serum levels of tumor necrosis factor α, interleukin(IL) -2, IL-6, IL-10, fever time, rale disappearance time and mechanical ventilation time in each group were observed at different time points.

Results The arterial oxygen partial pressure, pulse oxygen saturation and oxygenation index in the PP and PP+SW groups were significantly higher than those in SP and SP+SW groups at all time points(P <0.01), and the alveolar artery oxygen partial pressure and carbon dioxide partial pressure in the PP and PP+SW groups were significantly lower than those in SP and SP+SW groups(P <0.01).After 48 and 72 h of mechanical ventilation, the sputum output in PP+SW group was significantly lower than that in other 3 groups(P <0.01).The levels of tumor necrosis factor α, IL-2, IL-6 and IL-10 in the PP+SW group at 24, 48 and 72 h were significantly lower than those in other 3 groups(P <0.01).The duration of fever, lung rales, lesion absorption and mechanical ventilation in the PP+SW group were significantly lower than those in other 3 groups(P <0.01).

Conclusions Prone position ventilation combined with high-frequency chest wall oscillation expectoration and SW can improve the oxygenation index, reduce the viscosity of airway sputum, facilitate expectoration, control the body's inflammatory and immune response, and promote the recovery of clinical symptoms in children with severe pneumonia.