Annotated Bibliography
Arens R, Gozal D, Omlin KJ, Vega J, Boyd KP, Keens
TG, Woo MS. Comparison of high frequency chest compression
and conventional chest physiotherapy in hospitalized patients
with cystic fibrosis. 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.
Darbee JC, Kanga JF, Ohtake PJ. Physiologic evidence for high-frequency
chest wall oscillation and positive expiratory pressure breathing in hospitalized
subjects with cystic fibrosis. Phys Ther. 2005 Dec; 85(12):1278-89.
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The objectives of this study were 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
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.
Oermann CM, Sockrider MM, Giles D, Sontag MK, Accurso FJ, Castile RG.
Comparison of high-frequency chest wall oscillation and oscillating positive
expiratory pressure in the home management of cystic fibrosis: a pilot study.
Pediatr Pulmonol. 2001 Nov;32(5):372-7.
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The three primary objectives of this study comparing HFCWO and oscillating
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.
Varekojis SM, Douce FH, Flucke RL, Filbrun DA, Tice JS, McCoy KS, Castile
RG. 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. 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. |
