Non-invasive ventilation assists chest physiotherapy in adults with acute exacerbations of cystic fibrosis

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

“…Studies on the efficacy of NIPPV for decreasing pulmonary secretions are mainly inconclusive. Fauroux et al and Holland et al found no significant difference in respiratory clearance between the NIPPV and respiratory physiotherapy by stimulation of cough (21,22). 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 their study, level of SPO 2 in NIPPV group was significantly higher than that in the group receiving respiratory physiotherapy including respiratory exercises and chest wall massage. Moreover, Holland et al compared the efficacy of NIPPV and standard pharmaceutical therapy plus physiotherapy and reported significantly higher SPO 2 values in NIPPV group (P = 0.001) (21). However, these findings were in contrast to the results of Placidi et al who compared NIPPV with respiratory physiotherapy including stimulation of coughing and found no significant difference (1).…”

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

“…As far as we achieve patent airways, patients need to sustain expiratory flow actively to mobilize secretions. This might happen if positive pressure is applied during the whole respiratory cycle, together with active techniques, 18 and not only during the inspiratory phase alone, as previously described. 10,17 However, due to the lack of data about its use in CF as an airway clearance technique, and considering the reported end points, we can assume that CPAP alone has the same effects as PEP on airway clearance during expiration in this sample.…”

“…Respiratory physiotherapy is on the verge of a potentially exciting era in CF, and we require a change in approach in step with the increasing complexity of the disease and the new technology available. Positive pressure, delivered via NIV or CPAP, might be a valid tool, especially in advanced lung disease, 18,21,22 and it would require more attention and smarter outcomes. …”

Guidelines for Non-Invasive and Invasive Mechanical Ventilation for Treatment of Chronic Respiratory Failure

“…NIV is the primary therapeutic option for COPD patients with CRF [24, 25, 43 -47], whereas long-term invasive ventilation via a tracheostoma is only applied nowadays under exceptional circumstances, predominantly after weaning failure. NIV in combination with physiotherapy for cystic fibrosis can facilitate cough-up of thick, sticky mucous secretions [48].…”