The thesis covers the issues of increasing the efficacy of therapy in children with community-acquired pneumonia (CAP) by including the method of high-frequency chest wall oscillation (HFCWO) with the individually selected optimal mode in the therapeutic complex.
Oscillation criteria (vibration frequency, pressure, and duration of the procedure) and possible adverse events were studied in 261 children (138 boys - 52.9% and 123 girls - 47.1%) aged 6 to 17 years to form the optimal modes of HFCWO.
107 children aged 6 to 17 years were examined who underwent inpatient treatment being diagnosed moderate severity CAP with the acute and uncomplicated course for assessment the efficacy of the developed modes of HFCWO as a part of a comprehensive treatment. Two groups of children were formed of 58 boys (54.21 ± 7.6%) and 49 girls (45.79 ± 6.8%) taking into account the prescribed treatment of CAP among. The main group (MG) consisted of 55 children who received comprehensive treatment, which included basic therapy (BT) and an algorithm of ACT with the HFCWO procedures (“The Vest Airway Clearance System”) and breathing exercises (“DHD CliniFLO”). The control group (CG) consisted of 52 children, compared with MG, which was administered only BT.
The criteria of HFCWO were modified for the treatment of children with CAP with individualization of values of frequency, pressure, duration, and developed new optimal modes (1,2,3,4,5,6) taking into account age, type of constitution, body mass index (BMI), and oxygen saturation. It was established that it was advisable to administer gentle modes (1, 3, and 5) of HFCWO with lower values of the oscillation criteria for procedures in the treatment of the children of the asthenic type of constitution with CAP compared with the children of the normosthenic type of constitution.
The safety of HFCWO in children with CAP has been determined, which is confirmed by the low frequency (10.74% of cases) of detection of adverse events and their short duration.
The scientific data on the current course of CAP in children of different ages and types of the constitution has been supplemented from the viewpoint of leading clinical signs and syndromes, oxygen saturation, the function of external respiration, type of its disorders, peak expiratory flow.
The effectiveness of HFCWO as a part of comprehensive treatment of CAP in children is proved, which is confirmed by positive dynamics of clinical symptoms (absence of shortness of breath, decrease in intensity and productivity of cough, number of râles). The improvement of the ventilation function was established in 96.36% of the MG children in comparison with CG children - 86.54%. The safety of HFCWO has been proven by the short duration of adverse events in the children with CAP during a 10-day comprehensive treatment.
An algorithm of ACT based on the procedures of HFCWO using the device “The Vest” and breathing exercises using the training device “DHD CliniFLO” in the comprehensive therapy of CAP in children was developed and proposed.
An improved method of treatment of children with moderate severity CAP with the acute and uncomplicated course by including the HFCWO method in comprehensive treatment is proposed (Patent of Ukraine for utility model N 114857 dated March 27, 2017).
Recommendations are developed for optimal regimens of HFCWO with individualization of values of the oscillation criteria that were adapted taking into account the age, type of constitution, BMI, and oxygen saturation of a child for administration of procedures as a component of complex treatment of CAP in children.
Key words: pneumonia, high-frequency chest wall oscillation, oscillation modes, pulmonary function test, treatment, children.
