Safety and effectiveness of the high-frequency chest wall oscillation vs intrapulmonary percussive ventilation in patients with severe COPD

Abstract

PurposeChest physiotherapy is an important tool in the treatment of COPD. Intrapulmonary percussive ventilation (IPV) and high-frequency chest wall oscillation (HFCWO) are techniques designed to create a global percussion of the lung which removes secretions and probably clears the peripheral bronchial tree. We tested the hypothesis that adding IPV or HFCWO to the best pharmacological therapy (PT) may provide additional clinical benefit over chest physiotherapy in patients with severe COPD.MethodsSixty patients were randomized into three groups (20 patients in each group): IPV group (treated with PT and IPV), PT group with (treated with PT and HFCWO), and control group (treated with PT alone). Primary outcome measures included results on the dyspnea scale (modified Medical Research Council) and Breathlessness, Cough, and Sputum scale (BCSS), as well as an evaluation of daily life activity (COPD Assessment Test [CAT]). Secondary outcome measures were pulmonary function testing, arterial blood gas analysis, and hematological examinations. Moreover, sputum cell counts were performed at the beginning and at the end of the study.ResultsPatients in both the IPV group and the HFCWO group showed a significant improvement in the tests of dyspnea and daily life activity evaluations (modified Medical Research Council scale, BCSS, and CAT) compared to the control group, as well as in pulmonary function tests (forced vital capacity, forced expiratory volume in 1 second, forced expiratory volume in 1 second/forced vital capacity%, total lung capacity, residual volume, diffusing lung capacity monoxide, maximal inspiratory pressure, maximal expiratory pressure) and arterial blood gas values. However, in the group comparison analysis for the same variables between IPV group and HFCWO group, we observed a significant improvement in the IPV group maximal inspiratory pressure, maximal expiratory pressure, BCSS, and CAT. Similar results were observed in changes of sputum cytology with reduction of inflammatory cells (neutrophils and macrophages).ConclusionThe two techniques improved daily life activities and lung function in patients with severe COPD. IPV demonstrated a significantly greater effectiveness in improving some pulmonary function tests linked to the small bronchial airways obstruction and respiratory muscle strength and scores on health status assessment scales (BCSS and CAT) as well as a reduction of sputum inflammatory cells compared with HFCWO.

Safety of mechanical lung vibrator and high‐frequency chest wall oscillation in patients with cardiac implantable electronic device

“…Previous studies demonstrated the effect of CPT aided by chest wall vibration or HFCWO on prevention of ventilator‐associated pneumonia 1‐4 . CPT has been used as an adjunctive therapy to facilitate secretion clearance in elderly patients with underlying pulmonary diseases, such as non‐CF bronchiectasis, asthma, and chronic obstructive pulmonary disease 5‐11 . However, there is concern over whether direct pressure or vibration delivered to the chest wall by CPT devices would cause EMI or noise sensing by CIEDs.…”

“…Several CPT techniques have been studied to prevent atelectasis leading to pulmonary infection including ventilator‐associated pneumonia 1‐4 . Recent studies have investigated the efficacy of CPT also for elderly patients with non‐cystic fibrosis (CF) bronchiectasis, asthma, or chronic obstructive pulmonary disease, 5‐11 not only for young adult and pediatric patients with CF 12‐14 . There have been concerns about electromagnetic interference (EMI) and lead integrity problems during CPT using vibrating devices in patients with cardiac implantable electronic devices (CIED).…”

Persistent Pulmonary Atelectasis in Patient with Rheumatoid Arthritis Treated with High-Flow Therapy and High-Frequency Chest Wall Oscillation

“…The typical treatment lasts 20-30 minutes, and consists of short periods of compression at different frequencies, separated by coughing. HFCWO has been shown to be effective in clearing secretions from the lungs of patients with bronchiectasis, asthma, cystic fibrosis, primary ciliary dyskinesia, emphysema, COPD [7] and in neuromuscular patient [8][9][10]. The combination of the rehabilitative methods allowed the total resolution of atelectasis in 3 weeks.…”

Rehabilitation programs for patients with COronaVIrus Disease 2019: consensus statements of Taiwan Academy of Cardiovascular and Pulmonary Rehabilitation

“…Although less effective than intrapulmonary percussive ventilation, HFCWO has been shown to reduce dyspnea and improve pulmonary function. 46 Apart from clearing airway secretions, prone positioning, which is best performed early in the disease course (ideally within 48 h) when the P/F ratio is <150 mmHg, continues to play a vital role in the management of ARDS. 47 Combined with low tidal volume ventilation (around 6 mL/kg), recommendations suggest that prone positioning be maintained for 16 h daily.…”