Which method should the neonatal/pediatric specialist recommend for an 8-year-old child with cerebral atrophy to promote bronchial hygiene while delivering a bronchodilator?

The best method to promote bronchial hygiene for an 8-year-old child with cerebral atrophy while delivering a bronchodilator is intrapulmonary percussive ventilation. This technique combines the benefits of airway clearance and bronchodilation in a way that can be particularly effective for children with neuromuscular impairments.

Intrapulmonary percussive ventilation utilizes high-frequency ventilation along with positive pressure, which creates mini coughs that help mobilize secretions in the airways. This is especially beneficial in patients with conditions like cerebral atrophy where muscle weakness can compromise normal coughing and airway clearance mechanisms. The delivery of a bronchodilator can be integrated into this method, aiding in the dilation of the airways while concurrently promoting secretion clearance.

The other methods, while they have their own applications, do not combine these features as effectively. For example, intermittent positive pressure breathing is primarily used as a form of ventilatory support rather than direct airway clearance. External chest wall percussive devices, although beneficial for mobilizing secretions, do not provide the same simultaneous bronchodilator delivery capability as intrapulmonary percussive ventilation. In-exsufflator devices are also valuable for facilitating cough but may not integrate well with bronchod