Comparing the Performance Characteristics of Different Positive Expiratory Pressure Devices

Franks, Lisa J; Walsh, James; Hall, Kathleen; Jacuinde, Guillermo; Yerkovich, Stephanie T.; Morris, Norman

doi:10.4187/respcare.06410

Cited by 13 publications

(17 citation statements)

References 45 publications

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“…Indeed, their mechanical effects such as PEP, oscillation frequency, and oscillation amplitude are strongly dependent on how the devices are used (eg, position, resistance settings, expiratory flow). 10,[12][13][14] In addition, between-device differences may interact with varying expired air-flow patterns obtained from patients with diverse conditions or disease severity. 15 In these conditions, suboptimum OPEP utilization is likely, which may, in turn, affect therapeutic efficacy.…”

Section: Introductionmentioning

confidence: 99%

Comparison of 6 Oscillatory Positive Expiratory Pressure Devices During Active Expiratory Flow

et al. 2019

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BACKGROUND: Air-flow oscillations generated by exhaling through oscillatory positive expiratory pressure (OPEP) devices favor airway clearance. Variations in mechanical properties between different devices may influence therapeutic efficacy. The objective of this study was to assess mechanical properties in vitro and to compare the performance of 6 OPEP devices at different resistance levels under active expiratory flow patterns. METHODS: 4 gravity-dependent OPEP devices (ie, Flutter, Gelomuc, Pari O-PEP, Shaker Medic Plus) and 2 gravity-independent OPEP devices (ie, Acapella Choice and Aerobika) were each tested at low, medium, and high resistance settings. All devices were independently connected to a pulmonary waveform generator that reproduced active exhalation flows. Expiratory flow-volume curves were retrieved from 4 subjects with different stages of obstruction severity and were scaled according to either peak expiratory flow (4, 6, and 8 L/s) or volumes (2, 3 and 4 L), thus amounting to 24 active exhalations. Resulting waveforms were divided into 4 parts and the 2 middle parts were used to extract the following mechanical data: positive expiratory pressure (PEP), maximum expiratory pressure (P peak), oscillation frequency, and flow oscillation amplitude. The percentage of tests achieving oscillation frequencies > 12 Hz and PEP > 10 cm H 2 O was calculated for each device. RESULTS: Mechanistic effects of the Acapella, Aerobika, and Shaker devices were not comparable. The Flutter, Gelomuc, and Pari devices behaved similarly and achieved more tests with optimum oscillation frequency and PEP values than the other devices. These 3 devices also produced the highest oscillation amplitudes at the low-resistance level, whereas the Aerobika elicited higher and consistent oscillation amplitudes at medium and high resistance settings. CONCLUSIONS: Operational parameters differed between and within devices, yet the Flutter, Gelomuc, and Pari devices were similar in many aspects. Therapeutic efficacy may depend on the selected OPEP device and set resistance.

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Section: Introductionmentioning

confidence: 99%

Comparison of 6 Oscillatory Positive Expiratory Pressure Devices During Active Expiratory Flow

et al. 2019

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“…This flow range was selected to be consistent with previous studies. [5][6][7][8]10,12,13 In particular, this flow range is within the range used by Poncin et al, 9 who based them on actual patient data (Fig. 2).…”

Section: Methodsmentioning

confidence: 59%

“…Our results confirm other reports that there is variability in the performance of devices designed to do the same thing. [5][6][7]16 For both PEP and OPEP, all devices vary in performance characteristics for each setting at a given simulated expiratory flow. Some devices had a higher flow amplitude at one setting but a better mean PEP at another; therefore, human studies are needed to determine which devices are most effective in clearing secretions.…”

Section: Discussionmentioning

confidence: 99%

“…Other studies of OPEP have included pressure frequency and amplitude as performance characteristics, but very few studies focused on flow frequency and amplitude [5][6][7][8]13 Our study used flow frequency and amplitude as performance characteristics because previous research suggests that flow, not pressure, is the key factor for mucus clearance. The results of our study indicate that there is a substantial difference between pressure frequency and amplitude compared to flow frequency and amplitude.…”

Section: Discussionmentioning

confidence: 99%

“…4 However, there is limited information about the technical performance of PEP devices themselves. [5][6][7][8] Of particular interest is a recent study by Poncin et al 9 comparing 6 OPEP devices (some not available in the United States). They noted that OPEP often produces 2 main salutary physiologic effects: (1) PEP to stabilize the airways and prevent collapse during expiration, 10 and (2) air-flow oscillations to facilitate mucociliary clearance.…”

Section: Introductionmentioning

confidence: 99%

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Performance Characteristics of Positive Expiratory Pressure Devices

Demchuk

Chatburn

2020

Respir Care

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BACKGROUND: Positive expiratory pressure (PEP) therapy imposes expiratory flow resistance to increase airway diameter and enhance mucus clearance. PEP is achieved several ways. Oscillatory PEP devices (OPEP) generate repeated occlusions that are known to reduce mucus viscosity. There are many marketed devices, but comparative performance is mostly unreported. The purpose of this study was to evaluate performance characteristics of many PEP/OPEP devices. For OPEP devices, we defined an optimal performance metric by creating an oscillation index that combines the OPEP performance characteristics. METHODS: PEP devices (TheraPEP, EzPAP, VersaPAP, Resistex, AccuPEP, AccuPAP, and Threshold PEP) and OPEP devices (Acapella DH, Acapella DM, Acapella Choice, ShurClear, Aerobika, VibraPEP, vPEP, and PocketPEP with and without the Oxyjet attachment) were tested by adjusting simulated expiratory flow from 5 L/min to 30 L/min in increments of 5 L/min using a standard flow meter. RESULTS: All devices showed varying performance characteristics. As expiratory flow increased, mean PEP increased for most devices. The TheraPEP showed a mean PEP of 13 cm H 2 O across all settings. For OPEP devices, there was a major difference between pressure and flow waveforms. The Acapella DH, ShurClear, and Aerobika showed the highest flow amplitude, flow frequency, and oscillation index. CONCLUSIONS: PEP devices behaved similarly and as expected, with increased pressure with increased flow (flow resistors) or flow independence (threshold resistors). There was much greater variation in the performance of the OPEP devices. A higher oscillation index indicates better mechanical performance characteristics. Many devices have similar characteristics. However, the devices with the highest oscillation index have the highest flow amplitude and frequency, which may indicate better clinical performance.

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Design and initial testing of a novel disposable oscillating positive expiratory pressure device

et al. 2022

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Comparing the Performance Characteristics of Different Positive Expiratory Pressure Devices

Cited by 13 publications

References 45 publications

Comparison of 6 Oscillatory Positive Expiratory Pressure Devices During Active Expiratory Flow

Comparison of 6 Oscillatory Positive Expiratory Pressure Devices During Active Expiratory Flow

Performance Characteristics of Positive Expiratory Pressure Devices

Design and initial testing of a novel disposable oscillating positive expiratory pressure device

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