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Research and
Evidence |
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Mucus
clearance through High Frequency Chest Wall Oscillation has
been studied since 1983, and the first human study was published
in 1989. Since then, in more than 50 studies, HFCWO has consistently
been shown to be a safe, effective, and valuable tool in the
treatment of retained secretions. In fact, the first cost
comparison study, published by BlueCross in 1994, detailed
a 50% reduction in total health care costs with HFCWO.
The
Annotated Bibliography below is a starting point for a
technical review, followed by additional papers regarding
HFCWO and the SmartVest® Airway
Clearance System. In addition, you will find helpful
links to other sites that are related to pulmonary disease
and the organizations that support pulmonary patients.
Additional references are available from Electromed, Inc. |
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Annotated
Bibliography |
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Arens
R, Gozal D, Omlin KJ, Vega J, Boyd KP, Keens TG, Woo MS. |
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Comparison
of high frequency chest compression and conventional chest
physiotherapy
in hospitalized patients with cystic fibrosis. |
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Am
J Respir Crit Care Med. 1994 Oct; 150(4): 1154-7. |
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The aim of this study was to compare conventional chest physical therapy to high frequency chest compression (another name for high frequency chest wall oscillation) during the course of a 14 day hospitalization for an acute pulmonary exacerbation of cystic fibrosis. Fifty children were randomly assigned to receive either conventional therapy or high frequency chest compression three times each day for the extent of their 14 day hospitalization. Numerous clinical and pulmonary values were collected at admission, after 7 days, and after 14 days of treatment. RESULTS: With one exception, there were no differences in the two groups at admission or after 7 and 14 days. The exception was a significant increase in wet sputum production one hour after high frequency chest compression was completed, although there was no difference in dry sputum weights and all sputum weights were similar after 24 hours of collection. The authors concluded that high frequency chest compression is equally effective to conventional therapy as applied consistently by respiratory therapists and as safe as conventional chest physical therapy.
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Darbee JC, Kanga
JF, Ohtake PJ. |
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Physiologic evidence for high-frequency
chest wall oscillation and positive expiratory pressure breathing
in hospitalized subjects with cystic fibrosis. |
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Phys
Ther. 2005 Dec; 85(12): 1278-89. |
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The objective of this study was to identify physiologic responses to two independent airway clearance techniques in subjects with cystic fibrosis. High frequency chest wall oscillation and low positive expiratory pressure techniques were compared. Subjects were clearly identified as those with moderate to severe pulmonary involvement with cystic fibrosis, admitted to the hospital for an acute pulmonary exacerbation. The design employed a randomized assignment to one intervention for the first day with the alternate intervention provided on day 2. At the concluding 2 days of the hospitalization, the order of interventions was reversed. Outcome measures included ventilation distribution, gas mixing, and oxygen saturation. The interventions were performed appropriately. Both high frequency chest wall oscillation and low positive expiratory pressure (PEP) were equally efficacious in improving ventilation distribution, gas mixing, and pulmonary function in hospitalized people with CF. The authors recommended that patient preference be carefully considered in the choice of these two airway clearance techniques.
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Oermann
CM, Sockrider MM, Giles D, Sontag MK, Accurso FJ, Castile RG. |
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Comparison of high-frequency chest wall oscillation and
oscillating positive expiratory pressure in the home management
of cystic fibrosis: a pilot study. |
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Pediatr
Pulmonol. 2001 Nov; 32(5): 372-7. |
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The
three primary objectives of this study comparing high frequency
chest wall oscillation (HFCWO) and oscillating positive expiratory
pressure (PEP) were to examine safety and efficacy, estimate
changes in spirometric values, and determine user satisfaction
between the two techniques. The study utilized a prospective
randomized crossover design, with a four week period for each
therapy. The instrument employed for the satisfaction survey
had been previously validated on a similar sample of subjects.
RESULTS. There were no significant differences among spirometric
values throughout the study, although HFCWO had a positive regression
slope suggesting that subjects with better-maintained lung function
showed the greatest improvement after treatment. There were no
obvious adverse effects with either therapy. HFCWO had the highest
efficacy score, oscillating PEP the highest convenience score;
and comfort scores showed no differences. Preference was closely
associated with perceived efficacy with HFCWO most preferred. |
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Varekojis
SM, Douce FH, Flucke RL, Filbrun DA, Tice JS, McCoy KS, Castile
RG. |
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A
comparison of the therapeutic effectiveness of and preference
for postural drainage and percussion, intrapulmonary percussive
ventilation, and high-frequency chest wall compression in hospitalized
cystic fibrosis patients. |
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Respir
Care. 2003 Jan; 48(1): 24-8. |
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The
authors compared the short-term efficacy and preference of
three airway clearance techniques in subjects with cystic
fibrosis. The techniques were conventional chest physical
therapy, high frequency chest wall compression (oscillation),
and intrapulmonary percussive ventilation. Twenty-four subjects
were hospitalized with an acute pulmonary exacerbation and
were recruited within 48 hours of admission. Subjects mean
age was 24 years and mean FEV1 was 39% of predicted. Each
of the techniques was used for two consecutive days in a
randomized, cross-over sequence. Outcome measures were wet
and dry sputum weights and a preference ranking based upon
a 5 point scale. RESULTS. Wet sputum weight was greatest
for intrapulmonary percussion ventilation with the other
techniques being similar to one another. Dry sputum weights
did not differ. The use of sputum weight as an accurate and
appropriate outcome measure of airway clearance is discussed.
The preference ranking in these 24 subjects indicated that
high frequency chest wall oscillation was the most preferred
overall and highest ranked for both convenience and ease
of use. The authors concluded that study limitations resulted
in the assessment that all three techniques were efficacious
and that the subjects should be given the opportunity to
experience each technique since preference is so important
to successful treatment. |
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1- Ohnsorg F. A Cost Analysis of High-Frequency Chest Wall Oscillation in Cystic Fibrosis. AM J Respir and Crit Care Med 1994; 149(4): A669.
2 - Plioplys AV, Lewis S, Kasnicka I. Pulmonary vest therapy in pediatric long-term care. Journal of the American Medical Director’s Association 2002 Sep-Oct; 3 (5): 318-321. |
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