Effect of chest wall vibration timing on peak expiratory flow and inspiratory pressure in a mechanically ventilated lung model

Differences in delivery of respiratory treatments by on-call physiotherapists in mechanically ventilated children: a randomised crossover trial

“…In this, as in other studies, PEF was used as a surrogate measure of airway clearance [5,8,9]. An enhanced PEF, or expiratory flow bias theoretically improves mucus movement from the peripheral to the central airways from where it could be removed by suction or a cough [20,21].…”

“…For NRP, forces applied during chest wall vibrations were not a significant contributory factor to the generation of PEF, since the size of the delivered inspiratory breath alone contributed to enhanced PEF. The effectiveness of chest wall vibrations may be related to, amongst other factors, the direction of force and the timing and coordination between the chest wall vibrations and the patient's breathing cycle (whether it is spontaneous or manually delivered) [9]. Studies in animals and lung models have demonstrated that an increase in absolute PEF and the creation of an expiratory airflow bias relative to inspiration improves the central flow of secretions.…”

Automated Rotational Percussion Bed and Bronchoscopy Improves Respiratory Mechanics and Oxygenation in ARDS Patients Supported with Extracorporeal Membrane Oxygenation

“…[6][7][8] Chest physiotherapy can augment expiratory flow and assist in secretion clearance during positive pressure ventilation. 6,9,10 Common chest physiotherapy techniques used are manual percussion/vest therapy, high-frequency percussive ventilation, and rotational vibration beds. Similarly, flexible bronchoscopy can be safely used to aid in secretion clearance in ARDS patients on MV.…”

A new tuning fork with different vibration frequencies as an aid to bronchopulmonary hygiene physiotherapy

“…In the majority of the studies the techniques of bronchial hygiene produced significant improvements related to a better removal of secretions and to a better lung function, but the authors concluded that there is not enough evidence to suggest or not suggest the bronchial hygiene maneuvers in patients with COPD or bronchiectasis [9].…”

“…The forces applied during the vibrations were recorded by a sensor under the hands of the physical therapist. The authors concluded that that safety and efficacy of respiratory physical therapy are influenced by the rhythm of the vibrations within the respiratory cycle; early vibrations can increase peak inspiratory pressure, whereas late vibrations, while not harmful, are not effective at increasing peak expiratory flow [9].…”