High-Frequency Chest Wall Compression Therapy in Neurologically Impaired Children

Abstract

BACKGROUND: Children with neurological impairment often suffer from insufficient airway secretion clearance, which substantially increases their respiratory morbidity. The goal of the study was to assess the clinical feasibility of high-frequency chest wall compression (HFCWC) therapy in neurologically impaired children with respiratory symptoms. METHODS: This was a single-center, investigator initiated, prospective study. Twenty-two subjects were studied for 12 months before and 12 months after initiation of HFCWC therapy, and 15 subjects were followed for an additional 12 months. The threshold of adherence to HFCWC therapy was 70%. The number of pulmonary exacerbations that required hospitalization was recorded. RESULTS: Forty-five percent of the subjects required hospital admission before initiation of HFCWC therapy. This rate decreased to 36% after the first year with HFCWC, and to 13% after the second year with HFCWC. There was a statistically significant reduction of the number of hospital days at follow-up, relative to before treatment. Use of an assisted-cough device or the presence of tracheostomy did not significantly affect hospitalization days. CONCLUSIONS: Regular HFCWC therapy may reduce the number of hospitalizations in neurologically impaired children.

Respiratory Implications of Pediatric Neuromuscular Disease

“…22 These techniques effectively clear the central airways of secretions but may be ineffective at mobilizing secretions from more peripheral airways. As a result, various mucus-mobilization techniques like intrapulmonary percussive ventilation [23][24][25] and high-frequency chest-wall compressions (HFCWC) [26][27][28] have been used to enhance the movement of secretions from the peripheral to the more central airways where they can then be coughed out or suctioned. Investigators have also tried altering the properties of mucus to make it easier for the patient to cough secretions out with a variety of inhaled medications, especially when secretion retention leads to lobar atelectasis.…”

“…Small studies in children with a variety of neuromuscular or neurological diseases have compared health-care utilization before and after HFCWC use. [26][27][28]79 Seven subjects with quadriplegic cerebral palsy demonstrated a significant reduction in episodes of pneumonia and more effective airway suctioning, defined as suctioning attempts in which sputum was recovered, in the 12 months after use of HFCWC compared with the 12 months before. 28 Furthermore, none of the subjects experienced adverse events resulting from HFCWC use.…”

“…Another observational study involving 22 neurologically impaired children also demonstrated a significant reduction in hospitalization rates from 45% before HFCWC use to 36 and 13% in the 1 and 2 y after its use. 26 A randomized, controlled trial involving 23 children with either cerebral palsy or NMD compared clinical outcomes, including duration of acute infections, adverse events, polysomnogram results, chest radiograph findings, and body mass index in a group who were treated with standard chest physiotherapy and another group who received HFCWC over 5 months. 79 There were no thera-py-related adverse events.…”

Current treatments in familial dysautonomia

“…Vibration of the chest wall produces oscillatory airflow, which, in turn, promotes mobilization of secretions from the distal airways toward the mouth. 58 HFCWO decreased the number hospitalizations, physician visits, and antibiotic use in a 1-year study of patients with FD. Regular use of the vest was associated with improved oxygen saturation.…”

Year in Review 2014: Airway Clearance

“…5 In patient populations in which generating an effective cough is problematic, the role of HFCWC is unclear. Fitzgerald et al 6 hypothesized that adherence to a long-term airway clearance regime including HFCWC in the home improves morbidity due to respiratory infections and reduces the number of hospitalizations for children with neurological impairment who are unable to generate an effective cough. Although the study demonstrated a reduction in the number of hospitalizations after initiation of HFCWC, the outcomes cannot be generalized due to small sample size (N ϭ 7), minimum study power, and lack of randomization.…”