Tracheal Mucus Clearance in High Frequency Oscillation. II. Chest Wall Versus Mouth Oscillation

King, M.; Phillips, D M; Zidulka, A.; Chang, H. K.

doi:10.1097/00132586-198510000-00011

Cited by 32 publications

(45 citation statements)

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“…These findings are consistent with those of King et al 21 Again, expiratory flow bias (expiratory Ͼ inspiratory flow) was compared with inspiratory flow bias in anesthetized dogs receiving mechanical ventilation with high frequency oscillations at 13 Hz. They found that mucus clearance was 2.4 times higher with expiratory bias than with inspiratory bias.…”

Section: Expiratory-inspiratory Flow Ratiosupporting

confidence: 90%

Intrapulmonary Effects of Setting Parameters in Portable Intrapulmonary Percussive Ventilation Devices

Toussaint¹,

Guillet²,

Paternotte³

et al. 2012

Respir Care

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BACKGROUND: Despite potential benefits of intrapulmonary percussive ventilation (IPV) in various respiratory diseases, the impact of setting parameters on the mechanical effects produced by IPV in the lungs is unknown. We hypothesized that changing the parameters on IPV would modulate these effects. This in vitro study aimed at comparing the changes in intrapulmonary effects resulting from changes in parameters in 3 portable IPV devices (IMP2, Impulsator, and Pegaso). METHODS: Parameters were set in 72 combinations of frequency (90 -250 cycles/min), inspiratory to expiratory (I/E) time ratio (from 1/2 to 3/1), and pressure (10 -60 cm H 2 O). Four resulting effects were recorded on a test lung via a pneumotachometer: the expiratory to inspiratory flow ratio (E/I flow ratio), the PEEP, the ventilation, and the percussion. Percussion was assessed by the end-slope of the pressure curve. Analysis of variance was used for data analysis. RESULTS: E/I flow ratio increased with increasing I/E time ratio (P < .001). The Pegaso produced the lowest E/I flow ratio. PEEP raised 6 cm H 2 O in both IMP2 and Impulsator, and 17 cm H 2 O in the Pegaso with increasing frequency (P < .01), pressure, and I/E time ratio (P < .001). In all devices, ventilation increased with increasing pressure and decreasing frequency (P < .001). Percussion increased with increasing frequency and decreasing I/E time ratio (P < .001), and with increasing pressure when I/E time ratio was 1/1 or less. The Pegaso provided the poorest percussion. CON-CLUSIONS: This study suggests that changing the parameters considerably modulates the mechanical effects produced by portable IPV devices in the lungs. Increasing frequency increased PEEP and percussion, but decreased ventilation. Increasing I/E time increased PEEP and E/I flow ratio, and decreased percussion. Finally, increasing pressure increased PEEP and ventilation. The Pegaso produced the highest PEEP, least percussion, and smallest change in E/I flow ratio.

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Section: Expiratory-inspiratory Flow Ratiosupporting

confidence: 90%

Intrapulmonary Effects of Setting Parameters in Portable Intrapulmonary Percussive Ventilation Devices

Toussaint¹,

Guillet²,

Paternotte³

et al. 2012

Respir Care

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“…It may be the combination of techniques that promote secretion clearance. Incorporating a slow inspiratory¯ow with IPPB may be important and chest wall vibrations during expiration may increase peak expiratory¯ow as well as intrathoracic airway narrowing [19]. The greater difference between inspiratory and expiratory air¯ow produced may favour two phase¯ow (gas liquid interaction) and enhanced tracheal mucus transport [20].…”

Section: Airway Clearancementioning

confidence: 99%

The use of positive pressure devices by physiotherapists

Denehy

Berney²

2001

Eur Respir J

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The aim of this paper is to review the indications for use by physiotherapists, such as physiological rationale and the comparative efficacy of intermittent positive pressure breathing (IPPB) and continuous positive airway pressure (CPAP). A brief discussion of nasal intermittent positive airway pressure is also included.The use of IPPB for post operative prophylaxis has not been supported in the literature. In patients with low lung volumes resulting from neuromuscular disease or spinal injury, IPPB may be useful in the acute phase to improve tidal volume and cough effectiveness.The physiological benefits of CPAP to improve lung volumes are well documented in the literature. Physiotherapists use CPAP as an intermittent application in patients with low lung volumes following surgery. It is predominantly used as a second line intervention in the presence of refractory atelectasis and poor gas exchange. It may also be indicated in other patient groups with similar physiological problems.Nasal intermittent positive airway pressure combines the beneficial effects of intermittent positive pressure breathing and continuous positive airway pressure. There have been many studies evaluating its effectiveness. These have been supportive for patients with neuromuscular disease and sleep disordered breathing, but more research is needed in patients with acute respiratory failure.

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“…We also tested HFO at 14 Hz, the justification for which was that Freitag et al 7 found that it was the most efficient frequency for HFO, and King et al observed that 13 Hz (very close to 14 Hz) delivered to the airway lumen had no significant benefit, but instead appeared to inhibit mucus transport. 25 By using a reciprocal air flow to simulate tidal breathing and conditioning the air flowing in both directions, the intact tube preparation essentially embodied the situation that probably occurs over most of the length of the trachea in vivo. This makes the tube preparation a more robust model than monodirectional air flow.…”

Section: Discussionmentioning

confidence: 99%

Symmetrical-Waveform High-Frequency Oscillation Increases Artificial Mucus Flow Without Changing Basal Mucus Transport in In Vitro Ovine Trachea

Tatkov

Pack

2011

Respir Care

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BACKGROUND:The efficacy of symmetrical-waveform high-frequency oscillating (HFO) air flow for airway secretion clearance is controversial and debated in the literature. METHODS: We conducted in vitro experiments with ovine tracheae to investigate the effects of symmetrical-waveform HFO on tracheal transport of artificial mucus. We mounted each trachea as an intact tube, with a 15 o head-down tilt, infused artificial mucus (10 mL over one hour) at the caudal end of the trachea, and measured mucus-transport velocity as the time between the beginning of infusion and the first appearance of artificial mucus over 2 near-infrared sensors at the rostral end of the trachea and by measuring the amount of mucus emerging. In a second series of experiments we opened each trachea flat and with video microscopy we measured the transport velocity of plaques over the endogenous mucus sheet. RESULTS: In the intact-trachea preparation, HFO at 20 Hz and 50 cm H 2 O increased mucus-transport velocity from 5.8 mm/min to 7.8 mm/min. HFO led to nearly half the artificial mucus being cleared during the infusion period. In the opened-trachea experiments the mean control transport velocity was 8.7 mm/min, and HFO, at 14 Hz or 20 Hz (and 50 cm H 2 O), did not significantly alter that velocity. CONCLUSIONS: Symmetrical-waveform HFO increases mucus-transport velocity and mucus clearance when a thick layer of mucus is present. This may be important when considering the mechanisms of mucus clearance and using HFO for secretion clearance.

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Tracheal Mucus Clearance in High Frequency Oscillation. II. Chest Wall Versus Mouth Oscillation

Cited by 32 publications

References 0 publications

Intrapulmonary Effects of Setting Parameters in Portable Intrapulmonary Percussive Ventilation Devices

Intrapulmonary Effects of Setting Parameters in Portable Intrapulmonary Percussive Ventilation Devices

The use of positive pressure devices by physiotherapists

Symmetrical-Waveform High-Frequency Oscillation Increases Artificial Mucus Flow Without Changing Basal Mucus Transport in In Vitro Ovine Trachea

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