WS21.1 Evaluation of the use of IPV for the treatment of atelectasis in cystic fibrosis

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While the majority of CF patients respond to any of the recognized airway clearance techniques (ACT), there are occasions where a specific ACT may prove more beneficial than others. Objectives We hypothesised that Intra Pulmonary Pressure Ventilation (IPV) would be an effective ACT in CF patients who have significant areas of atelectasis. Methods We report here a series of 3 CF patients with significant segmental atelectasis despite good adherence. Patients A, B and C were initially treated with an intensive airway clearance regimen of both positive expiratory pressure and autogenic drainage with no improvement. Patients A and B had bronchoscopies with no improvement. IPV was initiated as an out-patient in patient A, and as an in-patient in patients B and C. Patient C had previously been admitted to hospital for IV antibiotics with no resolution of atelectasis. Pulmonary function and chest radiographs (CXR) were performed prior to and post treatment. CXRs were objectively measured using the Brasfield score. Results All 3 patients had significant improvement in both their CXR and FEV1 (Table 1). Each patient tolerated IPV well with no adverse effects. Table 1 . Change in CXR and FEV1 pre and post treatment Patient Age (yrs) Area of atelectasis Brasfield score pre Brasfield score post FEV1 pre FEV1 post A 17 RLL 19/25 22/25 99% 105% B 15 RML 13/25 18/25 59% 79% C 14 L Lingula and RLL 15/25 20/25 76% 83% Conclusion This series of case studies demonstrates that IPV is an effective airway clearance tool in a select group of CF patients and it shows the need to individualise the ACT to the underlying pathology. There have only been a few short-term studies using IPV with mixed results, further studies are needed.