Articles: chest-wall-oscillation.
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Surg J R Coll Surg E · Dec 2007
Incentive spirometry decreases respiratory complications following major abdominal surgery.
Pulmonary complications are the leading cause of morbidity and mortality following major abdominal surgery. Chest physiotherapy aims to decrease the likelihood of these complications and hasten recovery. ⋯ In a nonrandomised pilot study of 263 patients we have found that the addition of the incentive spirometer, as part of an intensive post-operative physiotherapy programme, decreased the occurrence of pulmonary complications (6 vs 17%, p = 0.01) and length of stay on the surgical high dependency unit (3.1 vs 4 days p = 0.03). The two groups were comparable when age, sex, smoking history, the need for emergency surgery and post-operative analgesia were compared.
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Randomized Controlled Trial Comparative Study
Comparison of high-frequency chest wall oscillation with differing waveforms for airway clearance in cystic fibrosis.
High-frequency chest wall oscillation (HFCWO) is commonly used by cystic fibrosis (CF) patients for airway clearance. The primary objective of this study was to determine whether the use of a newer HFCWO device that generates oscillations with a triangular waveform results in greater sputum production than a commonly used device that generates oscillations with a sine waveform. ⋯ Single-session sputum production is comparable with sine and triangular waveform HFCWO devices. Longer term comparisons are needed to determine whether sustained use of the devices results in clinically important differences in outcomes.
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High-frequency airway clearance assist devices generate either positive or negative transrespiratory pressure excursions to produce high-frequency, small-volume oscillations in the airways. Intrapulmonary percussive ventilation creates a positive transrespiratory pressure by injecting short, rapid inspiratory flow pulses into the airway opening and relies on chest wall elastic recoil for passive exhalation. High-frequency chest wall compression generates a negative transrespiratory pressure by compressing the chest externally to cause short, rapid expiratory flow pulses, and relies on chest wall elastic recoil to return the lungs to functional residual capacity. ⋯ Yet, despite over 20 years of research, clinical evidence of efficacy for them is still lacking. Indeed, there is insufficient evidence to support the use of any single airway clearance technique, let alone judge any one of them superior. Aside from patient preference and capability, cost-effectiveness studies based on existing clinical data are necessary to determine when a given technique is most practical.
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Case Reports
Acute hypoxemia in a child with neurologic impairment associated with high-frequency chest-wall compression.
An 11-year-old child with cerebral palsy required hospital admission for respiratory distress following administration of high-frequency chest wall compression (HFCWC). The child had severe neurologic impairment and an ineffective cough effort. ⋯ Although highly effective in mobilizing mucus, HFCWC does not assist in removing airway secretions. In the absence of an effective cough, additional devices or techniques may be required.
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Randomized Controlled Trial Comparative Study
Effects of changes in lung volume on oscillatory flow rate during high-frequency chest wall oscillation.
The effectiveness of high-frequency chest wall oscillation (HFCWO) in mucolysis and mucous clearance is thought to be dependant on oscillatory flow rate (Fosc). Therefore, increasing Fosc during HFCWO may have a clinical benefit. ⋯ Significant increases in Fosc with CPAP-induced increases in lung volume were observed, suggesting that CPAP may be useful as a therapeutic adjunct in patients who have obstructive airway disease and who require HFCWO.