Chest Wall Oscillation Research Articles

Early physiotherapy and chest wall oscillation in patients with COVID-19 disease at the intensive care unit: a pilot clinical trial

Over the past few years, the early mobilization and rehabilitation of patients in the intensive care unit (ICU) has drawn a lot of interest from the clinical and scientific communities. An interdisciplinary team treating patients suffering from serious conditions should include physiotherapy. Additionally, physiotherapy is utilized to treat and prevent the side effects of extended immobility or sleep, as well as to improve respiratory function. The purpose is to improve residual functionality; to avoid new and repeated hospitalizations; to improve health and quality of life. Exercises for the entire body (including early in-bed cycling), specialized breathing exercises, chest mobilization, relief help, drainage postures, vibration, verticalization, and passive movements are all crucial components of COVID-19 physiotherapy. Our goal was to evaluate the changes of functional condition of patients with COVID-19 in the acute stage using different physiotherapy methods: complex measures against mono therapy. In the research, 28 subjects (15 men and 13 women) were involved. A total of 84 physiotherapy procedures were performed. In the first group, breathing exercises and chest wall oscillation were applied, in the second group – only chest wall oscillation. Respiratory physiotherapy (breathing exercises) plays an important role in reducing and preventing respiratory complications in COVID-19 patients treated at ICU. Early mobilization and chest wall oscillation are beneficial in COVID-19 patients. We note that we are the first to conduct an evidence-based study of physiotherapy in intensive care with COVID-19 patients. We hope that our pilot clinical trial gives opportunity to future researches.

Intrapulmonary Percussive Ventilation as a Lung Recruitment Strategy in Brain-Dead Organ Donors.

To determine the strength of the evidence evaluating the effectiveness of intrapulmonary percussive ventilation (IPV) as a safe alternative or adjunctive therapy to traditional chest physiotherapy (CPT) among potential organ donors. Literature search conducted from February 2015 to November 2015 using PubMed, Cumulative Index of Nursing and Allied Health Literature, Scopus, and bibliographies of pertinent articles. Search Terms: Intrapulmonary percussive ventilation, chest physiotherapy, chest wall oscillation, organ donors, and ventilation. Articles in English from 1994 to present directly compared IPV to CPT or conventional (no) therapy. Association of Critical-Care Nurses Levels of Evidence was used to determine the strength of evidence. Level B and level C articles were reviewed. No studies were found using IPV in the donor population. Results from studies using IPV in other populations indicated IPV had no adverse effects, improved sputum clearance and oxygenation, and reduced atelectasis and pneumonia in patients with artificial airways. Intrapulmonary percussive ventilation may be a safe and effective alternative or adjunctive to CPT therapy and improve the number of lungs available for transplantation. Clinical research is essential to determine the effectiveness of this therapy for lung recruitment in the donor population.

Application value of high frequency chest wall oscillation after operation of abdominal incisional hernia

Objective To investigate the application value of high frequency chest wall oscillation (HFCWO) after operation of abdominal incisional hernia. Methods A prospectively randomized double-blind study was adopted. Fifty patients who underwent operation of abdominal incisional hernia at the Huadong Hospital Affiliated to Fudan University between January 2014 and September 2015 were allocated into the HFCWO group (undergoing postoperative HFCWO) and control group [undergoing postoperative conventional chest physiotherapy (CPT )] using random number table. Observation indicators included: (1) adverse events, (2) pain perception index: postoperative pain intensity from 1 day to 5 days was assessed by visual analogue scale (VAS), (3) respiratory function: arterial oxygen saturation (SaO2), oxygenation index (OI), arterial partial pressure of oxygen (PaO2) and arterial partial pressure of carbon dioxide (PaCO2) at postoperative day 1, 3 and 5, (4) follow-up. The follow-up using outpatient examination and telephone interview was performed to detect the recovery of patients up to March 2016. Measurement data with normal distribution were represented as ±s. The comparisons between groups were evaluated with the t test. The repeated measurement data were done using the repeated measures ANOVA and the count data were analyzed using the chi-square test. Results Fifty patients were screened for eligibility and were allocated into the 2 groups, 25 in each group. (1) Adverse events: all the patients in the 2 groups underwent successfully treatment, without the occurrence of hypoxemia, hemodynamic instability, arrhythmia, bronchospasm, vomiting, wound dehiscence, shedding catheter and so on. (2) Pain perception index: VAS from before chest treatment to postoperative day 5 was from 1.7±1.0 to 1.5±1.1 in the HFCWO group and from 1.4±0.8 to 1.8±0.6 in the control group, with a statistically significant difference in the change trend of pain intensity between the 2 groups (F=0.02, P 0. 05). (4) Follow-up: 43 patients were followed up after discharge from hospital for 1-6 months, with a median time of 5 months. During the follow-up, patients were not complicated with chest tightness and shortness of breath, with good wound healing. Conclusion Compared with conventional chest physiotherapy, HFCWO could improve tolerability of patients and reduce the pain after operation of abdominal incisional hernia. Key words: Abdominal incisional hernia; Surgical procedures, operative; High frequency chest wall oscillation

Non-pharmaceutical management of respiratory morbidity in children with severe global developmental delay.

Children with severe global developmental delay (SGDD) have significant intellectual disability and severe motor impairment; they are extremely limited in their functional movement and are dependent upon others for all activities of daily living. SGDD does not directly cause lung dysfunction, but the combination of immobility, weakness, skeletal deformity and parenchymal damage from aspiration can lead to significant prevalence of respiratory illness. Respiratory pathology is a significant cause of morbidity and mortality for children with SGDD; it can result in frequent hospital admissions and impacts upon quality of life. Although many treatment approaches are available, there currently exists no comprehensive review of the literature to inform best practice. A broad range of treatment options exist; to focus the scope of this review and allow in-depth analysis, we have excluded pharmaceutical interventions. To assess the effects of non-pharmaceutical treatment modalities for the management of respiratory morbidity in children with severe global developmental delay. We conducted comprehensive searches of the following databases from inception to November 2013: the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, the Allied and Complementary Medicine Database (AMED) and the Cumulative Index to Nursing and Allied Health Literature (CINAHL). We searched the Web of Science and clinical trials registries for grey literature and for planned, ongoing and unpublished trials. We checked the reference lists of all primary included studies for additional relevant references. Randomised controlled trials, controlled trials and cohort studies of children up to 18 years of age with a diagnosis of severe neurological impairment and respiratory morbidity were included. Studies of airways clearance techniques, suction, assisted coughing, non-invasive ventilation, tracheostomy and postural management were eligible for inclusion. We used standard methodological procedures as expected by The Cochrane Collaboration. As the result of heterogeneity, we could not perform meta-analysis. We have therefore presented our results using a narrative approach. Fifteen studies were included in the review. Studies included children with a range of severe neurological impairments in differing settings, for example, home and critical care. Several different treatment modalities were assessed, and a wide range of outcome measures were used. Most studies used a non-randomised design and included small sample groups. Only four randomised controlled trials were identified. Non-randomised design, lack of information about how participants were selected and who completed outcome measures and incomplete reporting led to high or unclear risk of bias in many studies. Results from low-quality studies suggest that use of non-invasive ventilation, mechanically assisted coughing, high-frequency chest wall oscillation (HFCWO), positive expiratory pressure and supportive seating may confer potential benefits. No serious adverse effects were reported for ventilatory support or airway clearance interventions other than one incident in a clinically unstable child following mechanically assisted coughing. Night-time positioning equipment and spinal bracing were shown to have a potentially negative effect for some participants. However, these findings must be considered as tentative and require testing in future randomised trials. This review found no high-quality evidence for any single intervention for the management of respiratory morbidity in children with severe global developmental delay. Our search yielded data on a wide range of interventions of interest. Significant differences in study design and in outcome measures precluded the possibility of meta-analysis. No conclusions on efficacy or safety of interventions for respiratory morbidity in children with severe global developmental delay can be made based upon the findings of this review.A co-ordinated approach to future research is vital to ensure that high-quality evidence becomes available to guide treatment for this vulnerable patient group.

A study of the value of high frequency chest wall oscillation in patients with acute exacerbation of chronic obstructive pulmonary disease

To explore the safety and efficacy of high-frequency chest wall oscillation (HFCWO) in invasive mechanical ventilation patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD). A prospective, randomized, controlled trial was conducted. Thirty-five AECOPD patients with invasive mechanical ventilation were included in the intensive care unit of West China Hospital of Sichuan University from February 2012 to February 2013. The patients were randomly allocated into a HFCWO (H) group and a control group using SAS 9.1 software . The control group received routine therapy, while the H group received HFCWO, along with routine therapy. Invasive mechanical ventilation time, noninvasive ventilation time, total mechanical ventilation time, ICU stay time, hospital stay time and pH, oxygen index (OI) during the first 7 days were collected. At the same time, heart rate, blood pressure, respiratory rate, SpO2 and peak airway pressure before, during and after HFCWO and ventilation alarm of the H group were collected. The total mechanical ventilation time of patients in the H group was significantly shorter than that of the control group [(10 ± 6) d and (15 ± 8) d, P < 0.05]. But there were no significant differences between the 2 groups in invasive mechanical ventilation time, noninvasive ventilation time, ICU stay and hospital stay time (P > 0.05). There were no significant differences between the 2 groups in pH and oxygen index during the first 7 days (P > 0.05). There were no change in heart rate, blood pressure, respiratory rate, SpO2 and peak airway pressure before, during and after HFCWO in the H group (P > 0.05). Severe ventilator alarm(level 3) occurred in 3.67% patients, but there was no significant correlation between ventilation alarm and patient prognosis. HFCWO is very safe and comfortable in ventilated patients with AECOPD. It reduces the total mechanical ventilation time, but cannot improve the prognosis.

Vibration and its effect on the respiratory system

Vibration is a manual technique used widely to assist with the removal of pulmonary secretions. Little is known about how vibration is applied or its effect on the respiratory system. The purpose of this study was to describe mechanical consequences of vibration on the chest wall of a normal subject and the effects of vibration on expiratory flow rates and volumes. The effects of vibration were compared to other interventions of chest wall compression, chest wall oscillation, cough, huff from high lung volume, inspiration to total lung capacity with relaxed expiration, tidal breathing, and sham. Sixteen physiotherapists applied vibration and other interventions in a randomised order to the chest wall of a healthy adult female subject. The magnitude and direction of the force and the frequency of vibration were measured by an instrumented bed with seven load cells. Inductive plethsysmography measured the change in chest wall circumference with vibration. A heated pneumotachometer measured inspiratory and expiratory flow rates, which were integrated to provide volumes. Vibration was applied with a mean resultant force of 74.4 N (SD 47.1). The mean (SD) change in chest wall circumference and frequency of vibration were 0.8 cm (SD 0.4) and 5.5 Hz (SD 0.8) respectively. The mean peak expiratory flow rate was 0.97 l/s (SD 0.27). Peak expiratory flow rates with vibration were less than 20% of those achieved with cough or huff from high lung volume but greater than with chest wall compression, chest wall oscillation, relaxed expiration from total lung capacity, sham treatment or tidal breathing.

Pulmonary vest therapy in pediatric long-term care.

Pulmonary infections are common in children with quadriplegic cerebral palsy. High frequency chest wall oscillation with the vest therapy (VT) is used to promote pulmonary clearance and to prevent pneumonias in cystic fibrosis patients. The purpose of this study was to ascertain the effectiveness of VT in patients with quadriplegic cerebral palsy who reside in pediatric skilled nursing facilities. Seven individuals with quadriplegic cerebral palsy, who had frequent pulmonary infections were identified (age range: 7-28 years; median 19 years; 2 females and 5 males). Five had a tracheostomy and three an active seizure disorder. Clinical data was collected for 12 months before starting VT and during 12 months of VT. The total number of pneumonias that required antibiotics decreased from 36 per year before VT, to 18 during the year of VT (P < 0.05). The number of hospitalizations due to pneumonia decreased from 9 to 3. With VT, the frequency of effective suctioning of pulmonary secretions was significantly increased (P < 0.01). In the patients with epilepsy, with VT, the average monthly frequency of seizures decreased from 4 to 1, from 9 to 2, and from 9 to 1. VT resulted in more effective suctioning of pulmonary secretions, reduced incidence of pneumonia, and reduced number of hospitalizations for pneumonia. In patients with epilepsy, VT resulted in reduced seizure frequency. VT was tolerated well, without complications or side effects. Further clinical investigations of the use of VT in cerebral palsy are indicated.

Nitrogen washout during tidal breathing with superimposed high-frequency chest wall oscillation.

In order to assess the efficacy of high-frequency chest wall oscillation (HFCWO) superimposed on tidal ventilation, multiple-breath nitrogen washout curves were obtained in 7 normal seated subjects. To maintain a regular breathing pattern throughout the study, the subjects breathed synchronously with a Harvard ventilator set at a constant tidal volume and frequency for each subject during a trial period. Washout curves were obtained during 3 different maneuvers performed in random order. Series A was the control condition with no superimposed HFCWO. In Series B and C, HFCWO at 5 Hz was superimposed on the regulated tidal breathing; the magnitude of the oscillatory tidal volume measured at the airway opening was 20 ml for Series B and 40 ml for Series C. The nitrogen washout was clearly faster in Series C than in Series A for each subject. In Series B, there was an interindividual variability, with a washout rate either equal to that in Maneuver A or in Maneuver C, or intermediate between the two. When these washout curves were analyzed in terms of a simple monocompartment model, the time constant of the washout was found to decrease by 16 +/- 11% in Series B, and 25 +/- 7% in Series C compared with that in Series A. In this group of normal subjects, the correction of any inhomogeneity in the distribution of the ventilation is unlikely to explain these results because of the close fit of all washout curves to a monoexponential model. It is postulated that during inspiration HFCWO enhances gas mixing in the lung periphery and that during expiration it improves gas mixing in the airways.(ABSTRACT TRUNCATED AT 250 WORDS)