The Intrapulmonary Percussive Ventilator and Flutter Device Compared to Standard Chest Physiotherapy in Patients wit Cystic Fibrosis

Abstract

Stasis of viscid secretions in cystic fibrosis (CF) leads to chronic infection, inflammation, and lung destruction. Chest physiotherapy (CPT) has been used for many years to assist in the removal of these secretions. However, the need for independently administered CPT exists, particularly for adolescents and the older CF patient. Two devices, the intrapulmonary percussive ventilator (IPV) and the Flutter device (Flutter) have been promoted for this purpose. This study compares these devices to standard, manual CPT. There was no difference in sputum quantity produced with any method studied. Transiently lower oxygen saturation was noted with standard CPT compared with the IPV and Flutter. Inconsistent but significant improvements in flow rates were noted with the two devices compared to standard CPT. Important trends to lower lung volumes, probably indicating decreased air trapping, were also noted with all three therapies at 1 and 4 hours after administration. There were no adverse effects with any treatment regimen. Larger and longer studies of these devices compared to standard CPT and with each other are warranted to assess their value for independent administration of CPT in CF patients and to determine long-term effects on maintenance of pulmonary function.

Intrapulmonary Effects of Setting Parameters in Portable Intrapulmonary Percussive Ventilation Devices

“…IPV may be delivered via a face mask, a mouthpiece, an endotracheal tube, or a tracheostomy. Recent reports have suggested that IPV facilitates airway clearance and improves homogeneity of ventilation in patients with cystic fibrosis, [1][2][3][4][5] in patients with neuromuscular disorders with retention of mucus, 6,7 in patients with atelectasis, 8 -10 in burned patients with inhalation injury, [11][12][13] and in patients with COPD. 14 -17 Despite potential benefits related to the use of IPV therapy, the impact of setting parameters such as the ratio of inspiratory to expiratory time, the pressure, and the frequency on the mechanical effects produced by IPV devices is totally unknown.…”

Chest Physiotherapy in Cystic Fibrosis: Short-Term Effects of Autogenic Drainage Preceded by Wet Inhalation of Saline versus Autogenic Drainage Preceded by Intrapulmonary Percussive Ventilation with Saline

“…Flow interruption occurred at a frequency of 4–6 Hz [15, 18]. The IPV therapy was delivered with the same 10 ml of isotonic saline solution (0.9% NaCl).…”

“…IPV therapy combines internal thoracic percussion with aerosol inhalation. Intrapulmonary percussion is achieved by delivery of rapid small bursts of air along with a side stream of room air and nebulized solution via a unique sliding venturi: the Phasitron [1, 11, 15, 18]. The percussive ventilator device (IPV-2, Percussionaire, Sandpoint, Idaho, USA) was operated by respiratory physiotherapists, adjusting frequency and operating pressure within the above-mentioned ranges for each patient.…”

“…While CPT [13] requires a lot of assistance and has been associated with a fall in oxygen saturation [14, 15], pain and gastroesophageal reflux [16], IPV offers a new perspective. IPV combines internal thoracic percussion with aerosol inhalation.…”

Structure and Function of the Mucus Clearance System of the Lung

“…Three forms of therapy are provided during IPV: percussive oscillatory vibrations to loosen retained secretions, highdensity aerosol delivery to hydrate viscous mucous plugs, and positive expiratory pressure (PEP) to recruit alveolar lung units. IPV has been compared with other airway clearance therapies in CF and other disease groups (Natale 1994;Homnick 1995;Newhouse 1998;Scherer et al 1998;Toussaint 2003).…”