Nonpharmacologic Airway Clearance Therapies

McCool, F. Dennis; Rosen, Mark J.

doi:10.1378/chest.129.1_suppl.250s

Cited by 181 publications

(40 citation statements)

References 51 publications

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“…As both techniques are equally efficacious in dislodging airway secretions, [4,9,10] it is not our intention to detect which is better than the other. Rather, the change of P peak between baseline and 15 minutes after sputum suction in either group is our primary outcome.…”

Section: Methodsmentioning

confidence: 99%

“…[9] High-frequency chest wall oscillation (HFCWO), mimicking a “mini-cough” by compressing and relaxing the chest wall to generate an oscillated volume from the lungs, can dislodge airway secretions as efficiently as CCPT [4,9,10] and can therefore save manpower to conduct CCPT. [11] However, most studies that have reported no significant effects of HFCWO, as these outcome measurements focusing on mortality, hospital stay, [4] lung function [12,13] or BODE score (a multidimensional 10-point scale for evaluation of chronic obstructive pulmonary disease) [12] are not associated with the immediate effects of chest physical therapy and may be seriously affected by other factors such as disease severity.…”

Section: Introductionmentioning

confidence: 99%

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Instantaneous responses to high-frequency chest wall oscillation in patients with acute pneumonic respiratory failure receiving mechanical ventilation

Chuang

Chou²,

Lee³

et al. 2017

Medicine

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Background:Endotracheal intubation and prolonged immobilization of patients receiving mechanical ventilation may reduce expectoration function. High-frequency chest wall oscillation (HFCWO) may ameliorate airway secretion movement; however, the instantaneous changes in patients’ cardiopulmonary responses are unknown. Moreover, HFCWO may influence ventilator settings by the vigorous oscillation. The aim of this study was to investigate these issues.Methods:Seventy-three patients (52 men) aged 71.5 ± 13.4 years who were intubated with mechanical ventilation for pneumonic respiratory failure were recruited and randomly classified into 2 groups (HFCWO group, n = 36; and control group who received conventional chest physical therapy (CCPT, n = 37). HFCWO was applied with a fixed protocol, whereas CCPT was conducted using standard protocols. Both groups received sputum suction after the procedure. Changes in ventilator settings and the subjects’ responses were measured at preset intervals and compared within groups and between groups.Results:Oscillation did not affect the ventilator settings (all P > 0.05). The mean airway pressure, breathing frequency, and rapid shallow breathing index increased, and the tidal volume and SpO2 decreased (all P < 0.05). After sputum suction, the peak airway pressure (Ppeak) and minute ventilation decreased (all P < 0.05). The HFCWO group had a lower tidal volume and SpO2 at the end of oscillation, and lower Ppeak and tidal volume after sputum suction than the CCPT group.Conclusions:HFCWO affects breathing pattern and SpO2 but not ventilator settings, whereas CCPT maintains a steadier condition. After sputum suction, HFCWO slightly improved Ppeak compared to CCPT, suggesting that the study extends the indications of HFCWO for these patients in intensive care unit. (ClinicalTrials.gov number NCT02758106, retrospectively registered.)

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Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Instantaneous responses to high-frequency chest wall oscillation in patients with acute pneumonic respiratory failure receiving mechanical ventilation

Chuang

Chou²,

Lee³

et al. 2017

Medicine

View full text Add to dashboard Cite

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“…). This reflected consensus on best practice regarding the essential elements of MCP and clarified potential areas of ambiguity [3,7]. The protocol’s aim was to clearly define the MCP to be delivered whilst allowing sufficient flexibility to preserve the profession’s ethos of providing treatment according to individual need.…”

Section: Methodsmentioning

confidence: 99%

Evaluation of the effectiveness of manual chest physiotherapy techniques on quality of life at six months post exacerbation of COPD (MATREX): a randomised controlled equivalence trial

et al. 2012

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BackgroundManual chest physiotherapy (MCP) techniques involving chest percussion, vibration, and shaking have long been used in the treatment of respiratory conditions. However, methodological limitations in existing research have led to a state of clinical equipoise with respect to this treatment. Thus, for patients hospitalised with an exacerbation of Chronic Obstructive Pulmonary Disease (COPD), clinical preference tends to dictate whether MCP is given to assist with sputum clearance. We standardised the delivery of MCP and assessed its effectiveness on disease-specific quality of life.MethodsIn this randomised, controlled trial powered for equivalence, 526 patients hospitalised with acute COPD exacerbation were enrolled from four centres in the UK. Patients were allocated to receive MCP plus advice on airway clearance or advice on chest clearance alone. The primary outcome was a COPD specific quality of life measure, the Saint Georges Respiratory Questionnaire (SGRQ) at six months post randomisation. Analyses were by intention to treat (ITT). This study was registered, ISRCTN13825248.ResultsAll patients were included in the analyses, of which 372 (71%) provided evaluable data for the primary outcome. An effect size of 0·3 standard deviations in SGRQ score was specified as the threshold for superiority. The ITT analyses showed no significant difference in SGRQ for patients who did, or did not receive MCP (95% CI −0·14 to 0·19).ConclusionsThese data do not lend support to the routine use of MCP in the management of acute exacerbation of COPD. However, this does not mean that MCP is of no therapeutic value to COPD patients in specific circumstances.

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Section: Standard Therapeutic Strategiesmentioning

confidence: 99%

“…These techniques are patient-centred and variable and aim to aid the removal of secretions from the lung through non-pharmacological methods 13 . Whether these techniques have a clear impact on quality of life or reducing exacerbations has not been adequately proven, and most studies are limited to the CF patient population 13 . Additionally, the use of multidisciplinary exercise interventions (pulmonary rehabilitation [PR]) is seen as an integral part of multimodal management for several chronic diseases 14 .…”

Section: Standard Therapeutic Strategiesmentioning

confidence: 99%

What’s new in the management of adult bronchiectasis?

Koser

Hill

2017

F1000Res

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Bronchiectasis is a heterogeneous, chronic condition with many aetiologies. It poses a significant burden on patients and healthcare practitioners and services. Clinical exacerbations often result in reduced quality of life, increased rate of lung function decline, increased hospitalisation, and mortality. Recent focus in respiratory research, guidelines, and future management options has improved this clinical field in evidence-based practice, but further work and phase III clinical trials are required. This article aims to summarise and explore advances in management strategies in recent years and highlight areas of research and future focus.

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Nonpharmacologic Airway Clearance Therapies

Cited by 181 publications

References 51 publications

Instantaneous responses to high-frequency chest wall oscillation in patients with acute pneumonic respiratory failure receiving mechanical ventilation

Instantaneous responses to high-frequency chest wall oscillation in patients with acute pneumonic respiratory failure receiving mechanical ventilation

Evaluation of the effectiveness of manual chest physiotherapy techniques on quality of life at six months post exacerbation of COPD (MATREX): a randomised controlled equivalence trial

What’s new in the management of adult bronchiectasis?

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