High Frequency Chest Wall Oscillation Research Articles

In vitro comparative study of wall portbased high-frequency chest wall oscillation device and internal air-pulse generator device.

Owing to environmental and disease issues, the use of high-frequency chest wall oscillation (HFCWO) devices in hospitals is consistently increasing. This study proposes a cost-effective actuator-less HFCWO device that utilizes an external wall port utility in hospitals to generate the positive and negative pneumatic pressures required for HFCWO treatment instead of an embedded mechanical actuator. The manufactured prototype with the no-amplification (NO-AMP) setting contained an electric pressure regulator to enable intensity level adjustment and two solenoid valves to enable vibration frequency adjustment, whereas the prototype with the pre-amplification (PRE-AMP) setting contained an additional air reservoir and an air-pressure booster. The prototype device was tuned to output average local maximum values in the pressure waveform similar to a commercial VEST-205 device at an 8-12 Hz frequency and 2-4 pressure intensity levels. In vitro comparative experiments demonstrated that the prototype device showed similar local maximum pressures to those of the VEST-205 (mean absolute pressure difference, <3 mmH2O); in contrast, the proposed device showed significantly higher local minimum pressures than those of the VEST-205 (mean absolute pressure difference, >8 mmH2O). Additionally, the driving sound of the proposed device was 17.0-17.8 dB higher than that of VEST-205. We conclude that the proposed device has the potential to substitute for conventional HFCWO devices under the limited but most frequently used operating conditions, although more detailed modifications are necessary in future studies to improve its performance and clinical usability.

Modeling the effects of external oscillations on mucus clearance in obstructed airways.

Various therapeutic methods are employed to facilitate the clearance of secretions accumulated in the respiratory tracts of individuals with lower respiratory tract disorders. High-frequency chest wall oscillation (HFCWO) device, designed to apply variable amplitude and frequency vibrations to the individuals' chests, stands out among these therapies. In this study, the effectiveness of this treatment method was investigated numerically using computational fluid dynamics (CFD) on the generated mucus-obstructed bronchial geometry. The conducted analyses compared the effects of vibrations acting in the axial, radial, and tangential directions on the clearance of mucus, which exhibits non-Newtonian flow behavior with shear-thinning properties. Simultaneously, the effects of changes in vibration amplitude and frequency, pressure differentials, fluid properties, and ciliary movements on the flow were separately examined and interpreted. The findings demonstrate that ciliary movements are insufficient in mucus-accumulated airways, applied vibrations enhance mucus clearance, and potential improvements in flow are quite sensitive to boundary conditions.

Impact of High-Frequency Chest Wall Oscillation on Health Care Resource Use and Economic Outcomes in Adult Patients With Non-Cystic Fibrosis Bronchiectasis in the United States: A Pre-Post Cohort Analysis

Impact of High-Frequency Chest Wall Oscillation on Health Care Resource Use and Economic Outcomes in Adult Patients With Non-Cystic Fibrosis Bronchiectasis in the United States: A Pre-Post Cohort Analysis

High-frequency chest wall oscillation multiple times daily can better reduce the loss of pulmonary surfactant and improve lung compliance in mechanically ventilated patients

BackgroundHigh-frequency chest wall oscillation (HFCWO) has been widely recognized for its airway secretion clearance effectiveness in critically ill ICU patients. ObjectivesThe purpose of this randomized controlled trial is to validate and compare the effects of different frequencies of HFCWO on oxygenation, lung compliance, and pulmonary surfactant proteins (SPs) in critically ill patients admitted to the intensive care unit (ICU). MethodsSixty patients with severe craniocerebral injury treated with a tracheostomy and mechanical ventilation were randomized into three groups (20 patients in each group): a single group (treated with 30 minutes of HFCWO once daily) and a double group (treated with 30 minutes of HFCWO twice daily), and a blank group (treated without HFCWO). Primary outcome measures included results on several specific proteins (SP-A, SP-B, SP-C, and SP-D) in serum and alveolar lavage fluid. Secondary outcome measures were lung static compliance test and oxygenation. ResultsPatients in both the single and double groups exhibited significant oxygenation and static compliance improvement. Similar results were observed in changes in SPs concentrations in the alveolar lavage fluid. However, a significant reduction of SPs levels was observed in the serum. In the group comparison analysis for the same variables between the single and double group, twice daily HFCWO treatments showed a significantly better result. ConclusionCompared with HFCWO once daily, HFCWO twice daily is advantageous in patients with tracheostomy and prolonged ventilation, which demonstrated significantly greater effectiveness in improving oxygenation and lung static compliance linked to the increase of and SPs contents in the airways as well as a reduction of SPs shift from airways to the blood.

Racial and ethnic differences in patients enrolled in the national bronchiectasis and nontuberculous mycobacteria research registry

Demographic and socioeconomic factors are recognized to contribute to disparities in healthcare outcomes. Originally, bronchiectasis was described in a population of predominantly White ethnic group of patients in which racial disparity could not be identified. The U.S. Bronchiectasis Research Registry (BRR), a centralized database of adult patients with bronchiectasis and/or NTM from 18 clinical institutions across the U.S., was created to support the research of this condition. The aim of this study is to describe the racial and ethnic distribution of patients enrolled in the BRR and evaluate factors associated with healthcare disparities within manifestations of and/or the care delivered to this population.At the time of this study, 3600 patients with bronchiectasis and/or NTM were enrolled in the BRR. Of those, 3510 participants were included in these analyses. The population was predominantly non-HispanicWhite (n = 3143, 89.5%), followed by Hispanic or Latino (n = 149, 4.3%), Asian (n = 130, 3.7%) and non-Hispanic Black (n = 88, 2.5%) participants. Testing for cystic fibrosis, immunoglobulin deficiency, and mycobacteria was not different between races, but non-Hispanic Black patients were tested less frequently for alpha-1 antitrypsin (A1AT) deficiency compared to other groups (P = 0.01). The four groups did not differ in the proportion of Pseudomonas aeruginosa or Hemophilus influenzae. There was no statistically significant difference in use of high-frequency chest wall oscillation, pulmonary rehabilitation services, or suppressive macrolide treatment across the groups (P > 0.05).There is a disproportionately high percentage of non-Hispainc White patients compared to non-Hispanic Black patients and Hispanic or Latino patients in the BRR. However, we found an overall similarity of care of BRR patients, regardless of racial and ethnic group.

Short-term structural and functional changes after airway clearance therapy in cystic fibrosis

BackgroundAirway clearance therapy (ACT) with a high-frequency chest wall oscillation (HFCWO) vest is a common but time-consuming treatment. Its benefit to quality of life for cystic fibrosis (CF) patients is well established but has been questioned recently as new highly-effective modulator therapies begin to change the treatment landscape. 129Xe ventilation MRI has been shown to be very sensitive to lung obstruction in mild CF disease, making it an ideal tool to identify and quantify subtle, regional changes. Methods20 CF patients (ages 20.7 ± 5.1 years) refrained from performing ACT before arriving for a single-day visit. Multiple-breath washout (MBW), spirometry, Xe MRI, and ultrashort echo-time (UTE) MRI were obtained twice—before and after patients performed ACT using their prescribed HFCWO vests (average 4.7 ± 0.5 h). UTE MRIs were scored for structural abnormalities, and standard functional metrics were obtained from MBW, spirometry, and Xe MRI—FEV1,pp, LCI2.5, and VDPN4, respectively. ResultsSpirometry and Xe MRI detected significant improvements in lung function post-ACT. 15/20 patients showed improvements from a baseline median of 92% FEV1,pp. Similarly, 16/20 patients showed improvements in Xe MRI from a baseline median of 15.2% VDPN4. Average individual changes were +2.6% in FEV1,pp and -1.3% in VDPN4, but without spatial correlations to easily-identifiable causative structural defects (e.g. mucus plugs or bronchiectasis) on UTE MRI. ConclusionsLung function improved after a single instance of HFCWO-vest ACT and was detectable by spirometry and Xe MRI. The only common structural abnormalities were mucus plugs, which corresponded to ventilation defects, but ventilation defects were often present without visible abnormalities.

Airway clearance therapy in the school environment: Retrospective analysis of a cohort of pediatric patients with cystic fibrosis

BackgroundAdherence to airway clearance therapy (ACT) in pediatric cystic fibrosis (CF) patients is reported to be below 50% and inability to sustain daily care is linked to poor health outcomes7,8,9. Through a collaboration between a CF care center and several schools, we hypothesized that ACT completed at school by pediatric CF patients will improve lung function while decreasing pulmonary exacerbations (PEx), days of antibiotics (abx) and hospitalizations. MethodsThis was a retrospective case-control study at a single CF care center consisting of 50 CF patients age < 18 at time when data was recorded (2012–2020). The case group used high-frequency chest wall oscillation or positive expiratory pressure devices at school for at least 1 year after self-reported or physician identified inadequate use at home. Lung function and measures of healthcare utilization were collected. ResultsIn the case group (n = 14), paired t-tests showed that after initiation of ACT at school, there were significant reductions in PEx requiring IV or PO abx (P = 0.010), total days of abx (P = 0.032), and visits to the CF care center (P = 0.037). There was no change in these outcomes in the matched control group (n = 36). ConclusionsThis is the first known study to highlight an initiative between a CF care center and schools which utilized airway clearance devices at school to ensure pediatric CF patients completed ACT. Through increased adherence, this relationship was associated with improved health outcomes. Use of alternative strategies may help patients with CF sustain adequate airway clearance.

Locating Nidi for High-Frequency Chest Wall Oscillation Smart Therapy via Acoustic Imaging of Lung Airways as a Spatial Network

Locating Nidi for High-Frequency Chest Wall Oscillation Smart Therapy via Acoustic Imaging of Lung Airways as a Spatial Network

Effects of High-Frequency Chest Wall Oscillation on Acute Exacerbation of Chronic Obstructive Pulmonary Disease: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.

This study aimed to evaluate the efficacy of high-frequency chest wall oscillation for sputum expectoration and hospital length of stay in patients with acute exacerbations of chronic obstructive pulmonary disease. The improvements in pulmonary function and oxygenation were also investigated. This systematic review and meta-analysis followed the Preferred Reporting Items for Systematic Reviewand Meta-analyses (PRISMA) guidelines. Automated literature database searches were conducted from the earliest records to March 31, 2022. The methodological quality of the included studies was assessed using the Cochrane Risk of Bias tool (RoB 2.0), and meta-analysis software (RevMan 5.4) was used to analyze the data. From 5439 identified articles, 13 studies (with 756 patients) were included in this meta-analysis. Compared to other airway clearance techniques, HFCWO significantly increased expectorated sputum volume by 6.18 mL (95% CI: 1.71 to 10.64; I2 = 87%), shortened hospital stay by 4.37 days (95% CI: -7.70 to -1.05; I2 = 84%). However, FEV1 (%), PaO2, and PaCO2 did not improve significantly. AECOPD patients may benefit from HFCWO therapy. HFCWO enables AECOPD patients to excrete more sputum and shorten their hospital stays. However, due to heterogeneity among the included research, these results should be interpreted with caution.

Chest physiotherapy for pneumonia in adults.

Chest physiotherapy for pneumonia in adults.

Effects of High-Frequency Chest Wall Oscillation Expectoration System on Pulmonary Rehabilitation and Cortisol Function in Patients with Severe AECOPD.

Objective To investigate the effect of high-frequency chest wall oscillatory expectoration system (HFCWO) on pulmonary rehabilitation and cortisol function in patients with severe acute exacerbation of chronic obstructive pulmonary disease (AECOPD). Methods The 65 severe AECOPD patients admitted to our hospital from January 2019 to May 2020 were divided into group A with 33 cases and group B with 32 cases by random number table method. After 14 days of intervention, the improvement time of clinical symptoms in the two groups was recorded, and blood gas, lung function, inflammatory, and cortisol function-related indicators were evaluated before and after treatment. Results The remission time of expectoration, pulmonary signs, and hospital stay in group A were significantly shorter than those in group B (P < 0.05). Compared with before treatment, blood oxygen partial pressure (PaO2), forced vital capacity (FVC), forced expiratory volume at 1 s (EFV1), and EFV1/FVC increased significantly; blood carbon dioxide partial pressure (PaCO2), C-reactive protein (CRP), interleukin-6 (IL-6), white blood cell count (WBC), plasma cortisol (COR), and adrenocorticotropic hormone (ACTH) levels were significantly decreased, and the above indicators in group A increased or decreased more significantly than those in group B (P < 0.05); there was no significant difference in tolerance and adverse reactions between the two groups (P > 0.05). Conclusion HFCWO has good pulmonary rehabilitation effect in the treatment of severe AECOPD and can significantly improve the blood gas indexes, inflammation, and cortisol function of patients, which is safe and feasible.

High-Frequency Chest Wall Oscillation in Patients with COVID-19: A Pilot Feasibility Study.

Coronavirus 2019 disease presents in a spectrum that can range from mild viral infection to pneu- monia. Common symptoms of coronavirus disease 2019 pneumonia include cough, sputum, and shortness of breath. High-frequency chest wall oscillation is a pulmonary rehabilitation method used for the recovery of pulmonary functions and removal of secretions in the lungs. The aim of the study was to evaluate the efficacy of high-frequency chest wall oscillation on patients with coronavirus disease 2019 pneumonia. In this study, 100 patients, between 18 and 70 years old, with a positive polymerase chain reaction result for coronavirus disease 2019, were included. Standard medical treatment was applied to all patients. In group rehabilitation, high-frequency chest wall oscillation treatment was applied twice a day for 20 minutes for 5 days. No additional intervention was made to the control group. Pulmonary function tests and oxygenation were evaluated on the first and fifth days. Patients' high-flow oxygen, non-invasive mechani- cal ventilation, and invasive mechanical ventilation needs were evaluated and recorded. Compared with the control group, the forced expiratory volume in 1 second, forced vital capacity, and peak expiratory flow rates were statistically higher in the rehabilitation group on the fifth day (P < .05). On evaluating the oxygenation of patients, the fifth day to first-day oxygen saturation difference was signifi- cantly higher in rehabilitation group than in control group (P < .05). Furthermore, the number of patients who needed non-invasive mechanical ventilation was lower in the rehabilitation group (P < .05). This study demonstrated that pulmonary rehabilitation applied with the high-frequency chest wall oscillation device in patients with coronavirus disease 2019 in the early period contributed to the improvement of oxygenation by providing significant improvement as observed in the pulmonary function tests of the patients.

EFFECTS OF DIFFERENT EXERCISE THERAPIES ON OBSTRUCTION, DYSPNEA, AND QUALITY OF LIFE IN COPD PATIENTS: A SYSTEMATIC REVIEW

Abstract&#x0D; Objective: Chronic obstructive pulmonary disease (COPD) is the third leading cause of death and it causes pulmonary and extrapulmonary symptoms, also impacts the quality of life. Rigorous evidence on manual and mechanical chest physiotherapy is still scarce. Therefore, this review aims to evaluate the effects of different exercise therapies on obstruction, dyspnea and quality of life in obstructive patients.&#x0D; Materials and Methods: Databases such as Medline, BioMed Central, CINHAL and Cochrane were reviewed. We performed a systematic review of randomized controlled trials published from 2011 to 2020, to evaluate the effects of exercise therapies on obstruction, dyspnea and quality of life in obstructive patients. Methodological quality and risk of bias were assessed using the Cochrane tool.&#x0D; Results: Most of the trials supported the effectiveness of mechanical chest physiotherapy in improving obstruction, dyspnea and quality of life.&#x0D; Conclusion: High-to-moderate evidence shows that mechanical chest physiotherapy is useful in the improvement of obstruction, dyspnea and quality of life in obstructive patients.&#x0D; &#x0D; Keywords: Borg dyspnea scale, COPD, High-frequency chest wall oscillation, mMRC dyspnea scale, St. George Respiratory Questionnaire, Spirometry&#x0D;

EFFECT OF HIGH-FREQUENCY CHEST WALL OSCILLATION ON CLINICAL INDICES OF COMMUNITY-ACQUIRED PNEUMONIA IN CHILDREN.

The aim: To study the effect of high-frequency chest wall oscillation (HFCWO) on clinical indices of community-acquired pneumonia (CAP) in children. Materials and methods: The main clinical symptoms were assessed in 107 children (girls - 45.79% and boys - 54.21%) aged 6 to 17 years with acute and uncomplicated course of CAP of moderate severity. The main group (MG) consisted of 55 children who were prescribed basic therapy (BT) in combination with HFCWO procedures. The control group (CG) comprised 52 children who received BT exclusively. Results: In the children of MG, the intensity of cough decreased to 0.28 ± 0.06 points compared with children of CG - 0.5 ± 0.07 points (p <0.05) on the 10th day of treatment. A positive dynamics of CAP in the form of the amount of sputum reduction was revealed in the MG children up to 0.06 ± 0.03 points compared with the CG children - 0.42 ± 0.07 (p <0.05). On the 10th day of therapy the MG children with CAP had decrease in the number of râles in the lungs up to 0.08 ± 0.04 points compared with those of CG - 0.4 ± 0.07 points (p <0.05). Conclusions: High efficacy of HFCWO method in complex treatment of CAP in children is confirmed by the dynamics of the main clinical symptoms, such as reduction of intensity and productivity of cough as well as absence shortness of breath and moist râles in the lungs. The data obtained indicate recovery of mucociliary clearance (MCC) functions and the bronchopulmonary system as a whole.

HIGH-FREQUENCY CHEST WALL OSCILLATION: AIRWAY CLEARANCE MANAGEMENT FOR OBSTRUCTIVE PULMONARY DISEASE PATIENTS

&lt;p&gt;Ineffective mucous airway clearance is identified as the main concern in obstructive pulmonary disease. An impaired mucociliary mechanism and hyper secretive are leading to mucous retention. High-frequency chest wall oscillation (HFCWO) offers a great practical advantage for obstructive pulmonary disease treatment. A literature review was conducted to summarize the existing research evidence assessing the effectiveness and benefits of HFCWO as an airway clearance management among people with obstructive pulmonary disease. Literature was limited to accessible articles in the English language and sourced from electronic databases, PubMed and EBSCO, from their published date through 2010. Seven studies that fulfilled the inclusion criteria were included in the analysis. Two themes were identified from the summary of included studies, namely respiratory function improvement and quality of life outcomes. The overall results of the studies indicate that HFCWO positively affects health status and wellbeing in patients with excessive mucous production and impaired airway clearance mechanism. It also can be performed independently and enhances self-satisfaction. Thus, it will be advantageous to include the HFCWO in pulmonary rehabilitation. Further studies are needed to validate the effectiveness of HFCWO in obstructive pulmonary disease patients and develop better treatments in this field.&lt;/p&gt;

Optimal efficiency of high-frequency chest wall oscillations and links with resistance and compliance in a model of the lung

Chest physiotherapy is a set of techniques used to help the draining of the mucus from the lung in pathological situations. The choice of the techniques and their adjustment to the patients or to the pathologies remain as of today largely empirical. High-frequency chest wall oscillation (HFCWO) is one of these techniques, performed with a device that applies oscillating pressures on the chest. However, there is no clear understanding of how HFCWO devices interact with the lung biomechanics. Hence, we study idealized HFCWO manipulations applied to a mathematical and numerical model of the biomechanics of the lung. The lung is represented by a fluid–structure interaction model based on an airway tree that is coupled to a homogeneous elastic medium. We show that our model is driven by two dimensionless numbers that drive the effect of the idealized HFCWO manipulation on the model of the lung. Our model allows us to analyze the stress applied to an idealized mucus by the air–mucus interaction and by the airway walls deformation. This stress behaves as a buffer and has the effect of reducing the stress needed to overcome the idealized mucus yield stress. Moreover, our model predicts the existence of an optimal range of the working frequencies of HFCWO. This range is in agreement with the frequencies actually used by practitioners during HFCWO maneuvers. Finally, our model suggests that analyzing the mouth airflow during HFCWO maneuvers could allow us to estimate the compliance and the hydrodynamic resistance of the lung of a patient.

REAL-WORLD OUTCOMES IN VETERANS USING HIGH FREQUENCY CHEST WALL OSCILLATION FOR AIRWAY CLEARANCE

TOPIC: Obstructive Lung Diseases TYPE: Original Investigations PURPOSE: Veterans have a high COPD prevalence compared to the civilian population. In COPD, excess sputum production and accumulation in the lungs is a commonly reported symptom. Several neuromuscular disorders are also known to present the clinician with airway clearance management challenges. High Frequency Chest Wall Oscillation (HFCWO) therapy is a noninvasive airway clearance therapy that directly addresses the issues associated with excess sputum production. There is limited information regarding outcomes of HFCWO therapy within the veteran population. To address this evidence gap, we established an ongoing VA outcomes program to better understand patient-reported outcomes in the veteran population receiving HFCWO therapy. METHODS: Self-reported hospitalization patterns and metrics of airway clearance from veterans were assessed before and after initiation of HFCWO therapy in a data set drawn from the HFCWO Outcomes Registry (HFCWO-OR). Variables collected included demographics, hospitalizations, and respiratory symptoms. The study was comprised of patients with a blended mix of diagnoses (e.g., COPD, bronchiectasis, and various neuromuscular disorders) who received the Philips InCourage vest therapy system. RESULTS: 323 veterans met inclusion criteria in this retrospective analysis. In the 12-month interval prior to initiating HFCWO therapy, the number of patients who reported zero hospitalizations was 46.4% (149/321), compared with 75.0% (21/28) of patients who reported zero hospitalizations in the subsequent 12 months (p=0.005). Conversely, 20.9% (67/321) of patients reported three or more hospitalizations in the prior 12 months, compared with only 3.6% (1/28) in the subsequent 12 months (p=0.001). There was an overall 66.3% reduction in the annualized hospitalization rate after 12 months (0.357 hospitalizations/patient/year at 12 months, compared to 1.059 hospitalizations/patient/year prior to initiating vest therapy) (p=0.001). Those patients who subjectively rated their "overall respiratory health" as good, very good, or excellent increased from 10.5% (34/323) upon initiation of therapy to 60.7% (17/28) within 12 months (p=0.0002). Those who rated the "ability to clear your lungs" as good, very good, or excellent increased from 8.4% (27/322) to 67.9% (19/28) within 12 months. (p<.0001). CONCLUSIONS: Our analysis indicates that outcomes in a veteran population, as measured by the number of self-reported hospitalizations, respiratory health, and the ability to clear secretions, improved substantially after the initiation of HFCWO therapy. These improvements were sustained for at least one year and provide valuable insights into the value of HFCWO in the population served by the VA health system. CLINICAL IMPLICATIONS: In a veteran population, positive outcomes are associated with the use of high frequency chest wall oscillation. DISCLOSURES: Consultant relationship with Respirtech Technologies Please note: $5001 - $20000 by Tara Barto, source=Web Response, value=Consulting fee No relevant relationships by Sarah Daignault, source=Web Response Employee relationship with RespirTech Please note: 2015-Present Added 04/16/2021 by Gary Hansen, source=Web Response, value=Salary Employee relationship with RespirTech, A Philips Company Please note: 2019 - present Added 04/16/2021 by PRITESH PANDYA, source=Web Response, value=Salary No relevant relationships by Frederic Seifer, source=Web Response

Особенности функции внешнего дыхания у детей с внебольничной пневмонией

Актуальность. Новые возможности улучшения функции внешнего дыхания (ФВД) связаны с применением высокочастотной осцилляции грудной клетки (ВЧОГК), которая позволяет восстановить дренаж бронхиального дерева и оптимизировать легочную вентиляцию. Цель исследования — изучение и оценка ФВД у детей с внебольничной пневмонией (ВП). Материалы и методы. Проведено обследование 107 детей (основная группа (ОГ) — 55 человек и контрольная группа (КГ) — 52 человека) в возрасте 6–17 лет с ВП с острым и неосложненным течением. Дети ОГ получали базисную терапию (БТ) с проведением процедур ВЧОГК, тогда как дети КГ получали исключительно БТ. Исследовали ФВД в динамике лечения, применяя спирометрию. Результаты. В начале терапии ВП показатели ФВД в исследуемых группах имели несущественные различия. При анализе параметров ФВД у детей ОГ на 10-й день БТ отмечено повышение объема форсированного выдоха за 1-ю секунду (ОФВ1) (88,36 ± 1,55 %, p = 0,02), жизненной емкости легких (ЖЕЛ) (88,18 ± 1,53 %, p = 0,02), форсированной жизненной емкости легких (ФЖЕЛ) (86,77 ± 1,37 %, p = 0,03), максимальной объемной скорости воздуха на уровне выдоха 25 % (МОШ25) (90,10 ± 2,99 %, p = 0,02) и максимальной вентиляции легких (МВЛ) (88,31 ± 1,70 %, p = 0,04). Сравнивая показатели ФВД детей КГ, выявили менее выраженную динамику, в частности, ОФВ1 (81,65 ± 2,44 %), ЖЕЛ (82,95 ± 2,56), ФЖЕЛ (80,85 ± 2,09), МОШ25 (82,63 ± 3,08 %) и МВЛ (85,65 ± 1,99 %). При проведении ROC-анализа динамика восстановления ФВД у детей ОГ более заметна за счет улучшения МВЛ, о чем свидетельствует самая большая площадь под кривой ROC (ППК) — 0,99, ОФВ1 — ППК 0,94 и ОФВ1/ФЖЕЛ — ППК 0,94. У детей КГ была менее выражена динамика исследуемых параметров ФВД, что подтверждается МВЛ — ППК 0,63, ОФВ1 — ППК 0,79 и ОФВ1/ФЖЕЛ — ППК 0,89. Выводы. Для улучшения вентиляционной функции легких у детей с ВП необходимо проводить процедуры бронходренажа, используя ВЧОГК в составе БТ, о чем свидетельствуют полученные положительные результаты спирометрии.

Budget Impact of the Vest™ High Frequency Chest Wall Oscillation System for Managing Airway Clearance in Patients with Complex Neurological Disorders: A US Healthcare Payers' Perspective Analysis.

ObjectiveAs a recognized therapy to improve airway clearance, high-frequency chest wall oscillation (HFCWO) is used to manage reduced vital capacity in patients with complex neuromuscular disorders (cNMD). This study aimed to investigate the budget impact of HFCWO versus chest wall physical therapy (CWPT) from a US-commercial payer perspective.MethodsIn combination with a previously developed cost-effectiveness model, a budget impact model was developed to evaluate the incremental budgetary impact associated with introducing a HFCWO device over a 5-year time horizon. The model compared the cost implications associated with the commonly used CWPT procedure, as the current scenario, with a new scenario consisting of 80% of market share for HFCWO. The resource use and costs included in the analyses were costs associated with the HFCWO device (Vest™ System) and its consumables, patient training, and medical services such as hospitalization, medications, emergency room, and outpatient visits. The primary outcome measures included total and incremental budgetary impact per member per year (PMPY).ResultsIn a hypothetical plan of 1,000,000 members (men: 49.2%), 2099 patients with cNMD were estimated to be eligible to receive airway clearance services over 5 years. The new scenario (HFCWO and CWPT [US$24 PMPY]) was cost-saving compared with the current scenario (CWPT only [$34 PMPY]) with a cost reduction of US$9.46 PMPY. The model estimated a net cost-saving of US$1,594,131 and US$9,591,343 over 1 and 5 years, respectively.ConclusionThis study suggests the HFCWO technique to manage the reduction in vital capacity in patients with cNMD would lead to favorable budget impact results.

High-frequency chest wall oscillation may be cost saving for patients with complex NMDs in the USA

High-frequency chest wall oscillation may be cost saving for patients with complex NMDs in the USA