High-frequency percussive ventilation improves perioperatively clinical evolution in pulmonary resection*

Lucangelo, Umberto; Antonaglia, Vittorio; Zin, Walter A.; Confalonieri, Marco; Borelli, Massimo; Columban, Mario; S, Cassio; Batticci, Irene; Ferluga, Massimo; Cortale, Maurizio; Berlot, Giorgio

doi:10.1097/ccm.0b013e31819ef9e1

Cited by 41 publications

(21 citation statements)

References 38 publications

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“…Toussaint et al 1 reported significantly better secretion clearance (ie, a 40% increase in sputum weight) with IPV in a small randomized crossover trial in patients with Duchenne muscular dystrophy and excessive sputum production. Similar findings of significantly improved postoperative sputum production also were reported by Lucangelo et al 13 when IPV was applied to patients undergoing pulmonary resection. Although total postoperative sputum production was not different between treatment groups, patients treated with IPV cleared a greater amount of secretions more rapidly (ie, 72% of their total sputum was cleared by the fourth postoperative day, compared to 46% in the group managed with CPAP).…”

Section: Intrapulmonary Percussive Ventilationsupporting

confidence: 88%

Adjunct Therapies During Mechanical Ventilation: Airway Clearance Techniques, Therapeutic Aerosols, and GasesDiscussion

Kallet

2013

Respir Care

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Mechanically ventilated patients in respiratory failure often require adjunct therapies to address special needs such as inhaled drug delivery to alleviate airway obstruction, treat pulmonary infection, or stabilize gas exchange, or therapies that enhance pulmonary hygiene. These therapies generally are supportive in nature rather than curative. Currently, most lack high-level evidence supporting their routine use. This overview describes the rationale and examines the evidence supporting adjunctive therapies during mechanical ventilation. Both mechanistic and clinical research suggests that intrapulmonary percussive ventilation may enhance pulmonary secretion mobilization and might reverse atelectasis. However, its impact on outcomes such ICU stay is uncertain. The most crucial issue is whether aerosolized antibiotics should be used to treat ventilatorassociated pneumonia, particularly when caused by multi-drug resistant pathogens. There is encouraging evidence from several studies supporting its use, at least in individual cases of pneumonia non-responsive to systemic antibiotic therapy. Inhaled pulmonary vasodilators provide at least short-term improvement in oxygenation and may be useful in stabilizing pulmonary gas exchange in complex management situations. Small uncontrolled studies suggest aerosolized heparin with N-acetylcysteine might break down pulmonary casts and relieve airway obstruction in patients with severe inhalation injury. Similar low-level evidence suggests that heliox is effective in reducing airway pressure and improving ventilation in various forms of lower airway obstruction. These therapies generally are supportive and may facilitate patient management. However, because they have not been shown to improve patient outcomes, it behooves clinicians to use these therapies parsimoniously and to monitor their effectiveness carefully. Key words: high-frequency percussive ventilation; intrapulmonary percussive ventilation; inhaled nitric oxide; aerosolized prostacyclin; aerosolized heparin; metered-dose inhalers; heliox.

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Section: Intrapulmonary Percussive Ventilationsupporting

confidence: 88%

Adjunct Therapies During Mechanical Ventilation: Airway Clearance Techniques, Therapeutic Aerosols, and GasesDiscussion

Kallet

2013

Respir Care

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“…It may also ventilate some alveoli otherwise not reached by the primary tidal volume [20]. We chose a pulsatile frequency of 500 cycles/min because it represents a good compromise between convection of gases at low percussion frequencies (180–240 cycles/min) and gas diffusion at a high oscillation (300–600 cycles/min), a phenomenon that may be linked to the increased kinetics of the oxygen molecules [13]. This high pulsatile frequency does not introduce a bias in the measurement since the P aw is similar to the mean alveolar pressure at frequencies of 5 and 10 Hz [21].…”

Section: Discussionmentioning

confidence: 99%

“…Thus, the two groups behaved differently, as depicted in figure 2. The improvement in Pa o 2 /Fi o 2 could be explained by three findings: (a) respiratory system compliance increased between baseline and 1 h after HFPV, possibly indicating an improvement in respiratory mechanics, which could suggest a certain degree of lung recruitment and improved ventilation/perfusion relationship (from the mechanical point of view HFPV has been reported to increase the C rs and decrease the work of breathing [30]); (b) our group described an increased lung secretion clearance, which was prolonged after the end of treatment [13], and (c) HFPV accommodates volume distribution without overinflating compartments with low time constants, thus presenting a potential beneficial behavior in mechanically heterogeneous lungs [31]. …”

Section: Discussionmentioning

confidence: 99%

“…On the other hand, high-frequency percussive ventilation (HFPV) has also been used to improve gas exchange. Previous studies have demonstrated the efficacy of HFPV in the treatment of closed head injury [9], acute respiratory diseases caused by burns and smoke inhalation [10,11], and obesity [12] and in patients after lung surgery [13]. Moreover, HFPV was found to be effective during chest physiotherapy in cystic fibrosis patients [14].…”

Section: Introductionmentioning

confidence: 99%

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Early Short-Term Application of High-Frequency Percussive Ventilation Improves Gas Exchange in Hypoxemic Patients

Lucangelo

Zin²,

Fontanesi³

et al. 2011

Respiration

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Background: Hypoxemia in acute lung injury/acute respiratory distress syndrome (ALI/ARDS) patients represents a common finding in the intensive care unit (ICU) and frequently does not respond to standard ventilatory techniques. Objective: To study whether the early short-term application of high-frequency percussive ventilation (HFPV) can improve gas exchange in hypoxemic patients with ALI/ARDS or many other conditions in comparison to conventional ventilation (CV) using the same mean airway pressure (P_aw), representing the main determinant of oxygenation and hemodynamics, irrespective of the mode of ventilation. Methods: Thirty-five patients not responding to CV were studied. During the first 12 h after admission to the ICU the patients underwent CV. Thereafter HFPV was applied for 12 h with P_aw kept constant. They were then returned to CV. Gas exchange was measured at: 12 h after admission, every 4 h during the HFPV trial, 1 h after the end of HFPV, and 12 h after HFPV. Thirty-five matched patients ventilated with CV served as the control group (CTRL). Results: Pao₂/Fio₂ and the arterial alveolar ratio (a/A Po₂) increased during HFPV treatment and a Pao₂/Fio₂ steady state was reached during the last 12 h of CV, whereas both did not change in CTRL. Paco₂ decreased during the first 4 h of HFPV, but thereafter it remained unaltered; Paco₂ did not vary in CTRL. Respiratory system compliance increased after HFPV. Conclusions: HFPV improved gas exchange in patients who did not respond to conventional treatment. This improvement remained unaltered until 12 h after the end of HFPV.

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“…NIV can enhance oxygenation and minute ventilation via two mechanisms, namely respiratory muscle unloading during inspiration and an increase in tidal volume associated with an increase in alveolar ventilation [21]. High-frequency percussive ventilation has been shown to significantly improve the PaO 2 /FiO 2 ratio in several categories of patients, including burn patients [26], obese patients with compression atelectasis [27], patients with acute respiratory distress syndrome [9,28], newborns [9], tracheotomised patients [29], and postoperative patients [30].…”

Section: Respiratory Rate and Gas Exchangementioning

confidence: 99%

Intrapulmonary percussive ventilation superimposed on spontaneous breathing: a physiological study in patients at risk for extubation failure

et al. 2011

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High-frequency percussive ventilation improves perioperatively clinical evolution in pulmonary resection*

Abstract: Under the present settings, HFPV improved oxygenation in one-lung ventilation during pulmonary resection. Postoperatively, it decreased the length of stay and increased the removal of secretions in comparison with CPAP.

Cited by 41 publications

References 38 publications

Adjunct Therapies During Mechanical Ventilation: Airway Clearance Techniques, Therapeutic Aerosols, and GasesDiscussion

Adjunct Therapies During Mechanical Ventilation: Airway Clearance Techniques, Therapeutic Aerosols, and GasesDiscussion

Early Short-Term Application of High-Frequency Percussive Ventilation Improves Gas Exchange in Hypoxemic Patients

Intrapulmonary percussive ventilation superimposed on spontaneous breathing: a physiological study in patients at risk for extubation failure

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