Non-invasive Ventilation as Airway Clearance Technique in Cystic Fibrosis

Hortal, M.C. Rodriguez; Nygren-Bonnier, Malin; Hjelte, Lena

doi:10.1002/pri.1667

Cited by 28 publications

(56 citation statements)

References 30 publications

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“…These results add to the argument that LCI may not be a suitable short-term end point for airways clearance trials as response is unpredictable. Previous studies reporting significant effects assessed treatment effect were not short term but over a period 4–48 weeks with inhaled therapies14 21 22 and 3 months with airways clearance therapy 23. Lack of overall change in LCI in this study was in agreement with other end points including spirometry, sputum weight and patient preference supporting the validity of these results.…”

Section: Discussionsupporting

confidence: 85%

“…FEV 1 is not always a suitable outcome measure for ACT trials due to its lack of sensitivity as an end point 28. LCI was chosen as the primary outcome measure in this study as it has demonstrated superior sensitivity to changes in disease compared with spirometry20 and has proven responsiveness to treatment effect with inhaled therapies14 21 22 and ACT23 in CF. However, in this study, LCI did not detect any change within or between treatments.…”

Section: Discussionmentioning

confidence: 99%

“…It is established that FEV 1 lacks sufficient sensitivity to detect changes in the peripheral airways 18. LCI has shown greater sensitivity to abnormalities in lung function compared with spirometry across the age ranges in CF19 20 and has proven responsiveness in trials of inhaled therapies21 22 and ACT23 in CF. Importantly, significant improvements in LCI have been reported with relatively small numbers of patients (n=17–25) 14…”

Section: Introductionmentioning

confidence: 99%

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Timing of hypertonic saline and airway clearance techniques in adults with cystic fibrosis during pulmonary exacerbation: pilot data from a randomised crossover study

et al. 2017

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BackgroundStreamlining the timing of treatments in cystic fibrosis (CF) is important to optimise adherence while ensuring efficacy. The optimal timing of treatment with hypertonic saline (HTS) and airway clearance techniques (ACT) is unknown.ObjectivesThis study hypothesised that HTS before ACT would be more effective than HTS during ACT as measured by Lung Clearance Index (LCI).MethodsAdults with CF providing written informed consent were randomised to a crossover trial of HTS before ACT or HTS during ACT on consecutive days. ACT treatment consisted of Acapella Duet. Patients completed LCI and spirometry at baseline and 90 min post treatment. Mean difference (MD) and 95% CIs were reported.Results13 subjects completed the study (mean (SD) age 33 (12) years, forced expiratory volume in 1second % (FEV1%) predicted 51% (22), LCI (no. turnovers) 14 (4)). Comparing the two treatments (HTS before ACT vs HTS during ACT), the change from baseline to 90 min post treatment in LCI (MD (95% CI) −0.02 (−0.63 to 0.59)) and FEV1% predicted (MD (95% CI) −0.25 (−2.50 to 1.99)) was not significant. There was no difference in sputum weight (MD (95% CI) −3.0 (−14.9 to 8.9)), patient perceived ease of clearance (MD (95% CI) 0.4 (−0.6 to 1.3) or satisfaction (MD (95% CI) 0.4 (−0.6 to 1.5)). The time taken for HTS during ACT was significantly shorter (MD (95% CI) 14.7 (9.8 to 19.6)).ConclusionsIn this pilot study, HTS before ACT was no more effective than HTS during ACT as measured by LCI.Trial registration numberNCT01753869; Pre-results.

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Section: Discussionsupporting

confidence: 85%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Timing of hypertonic saline and airway clearance techniques in adults with cystic fibrosis during pulmonary exacerbation: pilot data from a randomised crossover study

et al. 2017

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“…However, in the study by Fauroux et al the fatigue of patients after clearance in NIPPV group was less than that in patients who only received respiratory physiotherapy (22). In a recent study by Rodriguez Horta the effect of NIPPV compared to conventional chest physical therapy and positive expiratory pressure (PEP) on increasing the rate of airway clearance in CF was significant (23). They studied 32 subjects with Iran J Pediatr.…”

Section: Discussionmentioning

confidence: 99%

Efficacy of Noninvasive Positive Pressure Ventilation for Improving the Respiratory Function, Use of Accessory Respiratory Muscles, Quality of Sleep and Nutrition of Cystic Fibrosis Patients

et al. 2017

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Background: Respiratory failure secondary to recurrent respiratory infections is the most common cause of death in Cystic fibrosis (CF). Objectives: To assess the efficacy of noninvasive positive pressure ventilation (NIPPV) on respiratory function, use of accessory respiratory muscles, ease of physiotherapy for respiratory clearance, quality of sleep and nutritional status in CF patients with respiratory failure. Methods: All CF patients admitted to the pediatric department of Masih Daneshvari hospital, Tehran from March 2015 to January 2016 were studied. The inclusion criteria were clinical evidence of respiratory distress and signs of respiratory acidosis. The exclusion criteria were nausea and vomiting, not tolerating NIPPV, need for intubation, pneumothorax, presence of giant bullous emphysema or decreased level of consciousness. Baseline spirometry and venous blood gas (VBG) was obtained before and after NIPPV. A simple questionnaire was filled out for the nutritional status, sleep quality, ease of physiotherapy for airway clearance and the volume of secretions after NIPPV compared to baseline. Paired samples t-test and Wilcoxon Signed Rank test in SPSS version 16 were used for the before and after comparison of numerical and ordinal variables, respectively. Results: Out of a total of 53 CF hospitalized patients 17 met the inclusion criteria. There were 10 (58.8%) males and 7 (41.1%) females

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“…In CF, one study demonstrated a significant reduction (improvement) in LCI following treatment with NonInvasive Ventilation compared to Positive Expiratory Pressure mask in 32 patients with CF (22).…”

Section: Mbw Testingmentioning

confidence: 98%

Training in multiple breath washout testing for respiratory physiotherapists

et al. 2018

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Non-invasive Ventilation as Airway Clearance Technique in Cystic Fibrosis

Abstract: Non-invasive ventilation was shown to be a good alternative to PEP in chest physiotherapy for patients with cystic fibrosis who are severely ill.

Cited by 28 publications

References 30 publications

Timing of hypertonic saline and airway clearance techniques in adults with cystic fibrosis during pulmonary exacerbation: pilot data from a randomised crossover study

Timing of hypertonic saline and airway clearance techniques in adults with cystic fibrosis during pulmonary exacerbation: pilot data from a randomised crossover study

Efficacy of Noninvasive Positive Pressure Ventilation for Improving the Respiratory Function, Use of Accessory Respiratory Muscles, Quality of Sleep and Nutrition of Cystic Fibrosis Patients

Training in multiple breath washout testing for respiratory physiotherapists

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