Safety and Efficacy of Short-Term Intrapulmonary Percussive Ventilation in Patients With Bronchiectasis

Paneroni, Mara; Clini, Enrico; Simonelli, Carla; Bianchi, Luca; Antoni, Francesca Degli; Vitacca, Michele

doi:10.4187/respcare.01098

Cited by 44 publications

(60 citation statements)

References 21 publications

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“…Those studies were of good, 26 fair, 16,19,20,42 and poor 30,40 quality for this outcome. One good study of Flutter in mechanically ventilated subjects, and one fair study of IPV in subjects with COPD reported improved oxygenation in the intervention arms.…”

Section: Oxygenation and Gas Exchangementioning

confidence: 86%

“…Paneroni et al evaluated IPV and CPT in a crossover RCT that included 22 subjects with bronchiectasis. 26 The mean age of the subjects was 64.4 Ϯ 8.9 years, and the mean percent-of-predicted FEV 1 was 53 Ϯ 30%. The IPV arm included 3 active cycles alternating high and low pressure for 30 min.…”

Section: Studies Evaluating Cpt In Non-postoperative Subjectsmentioning

confidence: 97%

“…25 Similarly, for adults with bronchiectasis, a comparison of CPT versus IPV, rated as fair quality, reported no significant difference in sputum volume or weight. 26 Three different studies (all poor quality) of subjects with 3 different conditions assessed the effects of PEP versus CPT on sputum weight or in volume. Two studies reported no significant difference between PEP and the compari-son.…”

Section: Sputum Weight or Volumementioning

confidence: 99%

“…Seven studies of CPT in various populations, including children with asthma, 19,20,30 adults with COPD 16 or bronchiectasis, 26 and mechanically ventilated or postoperative subjects 40,42 reported no significant between-group differences in oxygenation. Those studies were of good, 26 fair, 16,19,20,42 and poor 30,40 quality for this outcome.…”

Section: Oxygenation and Gas Exchangementioning

confidence: 99%

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Nonpharmacologic Airway Clearance Techniques in Hospitalized Patients: A Systematic Review

et al. 2013

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SummaryNonpharmacologic airway clearance techniques are used to reduce the sequelae of obstructive secretions. We systematically reviewed comparative studies of nonpharmacologic interventions that health professionals can employ to achieve mucus clearance in hospitalized or postoperative patients without cystic fibrosis, over the age of 12 months. We searched MEDLINE and other databases from 1990 to 2012 to identify relevant literature. Two reviewers independently assessed each study against predetermined inclusion/exclusion criteria. Two reviewers also independently extracted data regarding subject and intervention characteristics and outcomes, and assigned overall quality ratings. The 32 studies meeting the review criteria included 24 randomized controlled trials, 7 crossover randomized controlled trials, and one prospective cohort study. Studies were typically small and together included a total of 2,453 subjects (mean 76/study). Studies generally examined chest physical therapy/physiotherapy modalities in postoperative or critically ill subjects or those with COPD. Interventions, comparators, and populations varied considerably across studies, hampering our ability to draw firm conclusions. Interventions, including conventional chest physical 2160RESPIRATORY CARE • DECEMBER 2013 VOL 58 NO 12 therapy/physiotherapy, intrapulmonary percussive ventilation, and positive expiratory pressure, typically provided small benefits in pulmonary function, gas exchange, oxygenation, and need for/duration of ventilation, among other outcomes, but differences between groups were generally small and not significant. Harms of the techniques were not consistently reported, though airway clearance techniques were generally considered safe in studies that did comment on adverse effects. Further research with clearly characterized populations and interventions is needed to understand the potential benefits and harms of these techniques.

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Section: Oxygenation and Gas Exchangementioning

confidence: 86%

Section: Studies Evaluating Cpt In Non-postoperative Subjectsmentioning

confidence: 97%

Section: Sputum Weight or Volumementioning

confidence: 99%

Section: Oxygenation and Gas Exchangementioning

confidence: 99%

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Nonpharmacologic Airway Clearance Techniques in Hospitalized Patients: A Systematic Review

et al. 2013

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“…Efficacy of percussive ventilation in clearing secretions relies on an asymmetric flow profile that favors expiration. 7 Using conventional frequencies in a 2 compartment test lung system, Volpe et al demonstrated parallel findings. 8 Differing compliances encouraged transfer of a mucus simulant from one ventilated test lung compartment to another across their shared carinal divider.…”

Section: Introductionmentioning

confidence: 91%

Ventilator-Associated Problems Related to Obstructive Lung DiseaseDiscussion

Marini

2013

Respir Care

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SummaryRelatively little attention has been directed toward damage inflicted upon the airway network that connects the alveoli, or toward the problems caused by invasive ventilation for patients with severe airflow obstruction. Mechanical ventilation with positive pressure can cause non-edematous barotrauma, inflict airway injury, and promote lung remodeling. Interactions between patient and ventilator, largely mediated through dynamic hyperinflation, include functional consequences for hemodynamics, respiratory muscle function, breathing work load, and patient-ventilator synchrony. Awareness of such associations not only helps to avoid complications during and after the critical phase of obstructive illness, but also opens a window to improved patient comfort and safety. The purpose of this review is to survey the range of structural damages and functional impairments that occur in an "obstructive" context.

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