CPAP Has No Effect on Clearance, Sputum Properties, or Expectorated Volume in Cystic Fibrosis

Aquino, Evanirso da Silva; Shimura, Francine; Santos, Adriana Silveira; Goto, Danielle Miyuki; Coelho, Cristiane Cenachi; Fuccio, Marcelo Bicalho de; Saldiva, Paulo Hilário Nascimento; Lorenzi-Filho, Geraldo; Rubin, Bruce K.; Nakagawa, Naomi Kondo

doi:10.4187/respcare.01705

Cited by 12 publications

(3 citation statements)

References 31 publications

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“…CPAP by face mask can alleviate hypoxemia due to low tidal volumes and airway obstruction, and may avoid reintubation, but there is no high-level evidence that this improves airway clearance. 59 PEP therapy is seen as a simple and less expensive alternative to CPAP. However, the routine use of PEP has no high-level evidence supporting its use, other than in patients with CF.…”

Section: Discussionmentioning

confidence: 99%

AARC Clinical Practice Guideline: Effectiveness of Nonpharmacologic Airway Clearance Therapies in Hospitalized Patients

et al. 2013

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Airway clearance therapy (ACT) is used in a variety of settings for a variety of ailments. These guidelines were developed from a systematic review with the purpose of determining whether the use of nonpharmacologic ACT improves oxygenation, reduces length of time on the ventilator, reduces stay in the ICU, resolves atelectasis/consolidation, and/or improves respiratory mechanics, versus usual care in 3 populations. For hospitalized, adult and pediatric patients without cystic fibrosis, 1) chest physiotherapy (CPT) is not recommended for the routine treatment of uncomplicated pneumonia; 2) ACT is not recommended for routine use in patients with COPD; 3) ACT may be considered in patients with COPD with symptomatic secretion retention, guided by patient preference, toleration, and effectiveness of therapy; 4) ACT is not recommended if the patient is able to mobilize secretions with cough, but instruction in effective cough technique may be useful. For adult and pediatric patients with neuromuscular disease, respiratory muscle weakness, or impaired cough, 1) cough assist techniques should be used in patients with neuromuscular disease, particularly when peak cough flow is < 270 L/min; CPT, positive expiratory pressure, intrapulmonary percussive ventilation, and high-frequency chest wall compression cannot be recommended, due to insufficient evidence. For postoperative adult and pediatric patients, 1) incentive spirometry is not recommended for routine, prophylactic use in postoperative patients, 2) early mobility and ambulation is recommended to reduce postoperative complications and promote airway clearance, 3) ACT is not recommended for routine postoperative care. The lack of available high-level evidence related to ACT should prompt the design and completion of properly designed studies to determine the appropriate role for these therapies.

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Section: Discussionmentioning

confidence: 99%

AARC Clinical Practice Guideline: Effectiveness of Nonpharmacologic Airway Clearance Therapies in Hospitalized Patients

et al. 2013

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“…This would have little effect on mucus clearance, but, coupled with an effective cough, it would be expected to improve sputum clearance in the proximal airway generations. 3,4 We evaluated the effects of CPAP, rather than positive expiratory pressure therapy, as the latter is more effort dependent. In these subjects with mild to moderate CF lung disease there was no benefit from CPAP therapy over the use of hypertonic saline alone.…”

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confidence: 99%

CPAP in Cystic Fibrosis: Is It Time to Surrender Yet?

Gambazza

Zuffo

2013

Respir Care

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“…The authors thank Gambazza and Zuffo for their interest in our paper evaluating hypertonic saline inhalation and CPAP, alone and in combination in subjects with cystic fibrosis (CF). 1 Gambazza and Zuffo are correct that there are few well controlled comparative studies of airway clearance techniques, in part due to the difficulty in masking and in meeting appropriate end points. 2 They are also correct in the observation that positive airway pressure, delivered either as positive expiratory pressure or CPAP, can maintain airway patency by moving the equal pressure point proximally in the airway: what they call airway "splinting."…”

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confidence: 99%

The authors respond to:CPAP in Cystic Fibrosis: Is It Time to Surrender Yet?

Rubin

Nakagawa

2013

Respir Care

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CPAP Has No Effect on Clearance, Sputum Properties, or Expectorated Volume in Cystic Fibrosis

Abstract: CPAP alone had no effect on mucus clearance, sputum properties, or expectorated volume, and did not potentiate the effect of HTS alone in CF subjects.

Cited by 12 publications

References 31 publications

AARC Clinical Practice Guideline: Effectiveness of Nonpharmacologic Airway Clearance Therapies in Hospitalized Patients

AARC Clinical Practice Guideline: Effectiveness of Nonpharmacologic Airway Clearance Therapies in Hospitalized Patients

CPAP in Cystic Fibrosis: Is It Time to Surrender Yet?

The authors respond to:CPAP in Cystic Fibrosis: Is It Time to Surrender Yet?

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