1
|
Gutmark E, Anand V, Wheeler A, Zahn A, Cavari Y, Eluk T, Hay M, Katoshevski D, Gutmark-Little I. Demonstration of mucus simulant clearance in a Bench-Model using acoustic Field-Integrated Intrapulmonary Percussive ventilation. J Biomech 2022; 144:111305. [PMID: 36137371 DOI: 10.1016/j.jbiomech.2022.111305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Revised: 09/08/2022] [Accepted: 09/11/2022] [Indexed: 11/24/2022]
Abstract
Intrapulmonary Percussive Ventilation (IPV) is a high-frequency airway clearance technique used to help in mucus transport for mechanically ventilated and unventilated patients. Despite the many years of usage, this technique does not provide clear evidence of its intended efficacy. This is mainly attributable to the lack of in vitro observations that show "mucokinesis" towards the direction of the mouth. In the current manuscript, we demonstrate and subsequently propose a mechanism that details the movement of a mucus simulant in the proximal (towards the mouthpiece) direction. Towards this end, a novel method utilizing a high-frequency acoustic field in addition to the conventional air pulsations brought forth by traditional IPV is proposed. Under these conditions, at certain parameter settings, it is shown that the simulant is broken down into much smaller parts and subsequently pushed in the upstream direction gradually over a period of half-hour.
Collapse
Affiliation(s)
- Ephraim Gutmark
- Department of Aerospace Engineering and Engineering Mechanics, University of Cincinnati, Cincinnati, OH 45221, USA.
| | - Vijay Anand
- Department of Aerospace Engineering and Engineering Mechanics, University of Cincinnati, Cincinnati, OH 45221, USA
| | - Aaron Wheeler
- Department of Aerospace Engineering and Engineering Mechanics, University of Cincinnati, Cincinnati, OH 45221, USA
| | - Alexander Zahn
- Department of Aerospace Engineering and Engineering Mechanics, University of Cincinnati, Cincinnati, OH 45221, USA
| | - Yuval Cavari
- Pediatric Intensive Care Unit, Soroka Medical Center, Beer-Sheva, Israel
| | - Tal Eluk
- Environmental Engineering Unit, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Maor Hay
- Environmental Engineering Unit, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - David Katoshevski
- Environmental Engineering Unit, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | | |
Collapse
|
2
|
Coppolo DP, Schloss J, Suggett JA, Mitchell JP. Non-Pharmaceutical Techniques for Obstructive Airway Clearance Focusing on the Role of Oscillating Positive Expiratory Pressure (OPEP): A Narrative Review. Pulm Ther 2021; 8:1-41. [PMID: 34860355 PMCID: PMC8640712 DOI: 10.1007/s41030-021-00178-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Accepted: 10/29/2021] [Indexed: 11/26/2022] Open
Abstract
Mucus secretion in the lungs is a natural process that protects the airways from inhaled insoluble particle accumulation by capture and removal via the mucociliary escalator. Diseases such as cystic fibrosis (CF) and associated bronchiectasis, as well as chronic obstructive pulmonary disease (COPD), result in mucus layer thickening, associated with high viscosity in CF, which can eventually lead to complete airway obstruction. These processes severely impair the delivery of inhaled medications to obstructed regions of the lungs, resulting in poorly controlled disease with associated increased morbidity and mortality. This narrative review article focuses on the use of non-pharmacological airway clearance therapies (ACTs) that promote mechanical movement from the obstructed airway. Particular attention is given to the evolving application of oscillating positive expiratory pressure (OPEP) therapy via a variety of devices. Advice is provided as to the features that appear to be the most effective at mucus mobilization.
Collapse
Affiliation(s)
| | | | | | - Jolyon P Mitchell
- Jolyon Mitchell Inhaler Consulting Services Inc., 1154 St. Anthony Road, London, ON, N6H 2R1, Canada.
| |
Collapse
|
3
|
Dickman R, Levy S, Perets TT, Hazani-Pauker M, Boltin D, Schmilovitz-Weiss H, Nidal I, Siterman M, Carter D, Fass R, Gingold-Belfer R. Effect of the transcutaneous electrical stimulation system on esophageal-acid exposure in patients non-responsive to once-daily proton-pump inhibitor: proof-of-concept study. Gastroenterol Rep (Oxf) 2021; 9:323-328. [PMID: 34567564 PMCID: PMC8460107 DOI: 10.1093/gastro/goab002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Revised: 09/28/2020] [Accepted: 11/26/2020] [Indexed: 11/16/2022] Open
Abstract
Background Gastroesophageal reflux disease (GERD) is a common disorder. Overall, ≤35% of GERD patients fail the standard dose of proton-pump-inhibitor (PPI) treatment. Due to the high prevalence and low satisfaction rate with treatment failure, there is an unmet need for new treatment. Our aim was to evaluate whether the use of the transcutaneous electrical stimulation system (TESS) can reduce esophageal-acid exposure in GERD patients unresponsive to standard-dose PPI. Methods We enrolled 10 patients suffering from heartburn and regurgitation with an abnormal esophageal-acid exposure (off PPIs) who failed standard-dose PPI. After the placement of a wireless esophageal pH capsule, all patients were treated with TESS. The primary end point was the reduction in the baseline (pretreatment) 24-hour percent total time pH <4 and/or DeMeester score by 50%. Results Seven GERD patients (five females and two males, aged 49.3 ± 10.1 years) completed the study. At baseline, the mean percent total time pH <4 was 12.0 ± 4.9. Following TESS, the mean percent total time pH <4 dropped to 5.5 ± 3.4, 4.5 ± 2.6, 3.7 ± 2.9, and 4.4 ± 2.5 on Days 1, 2, 3, and 4, respectively. At baseline, the mean DeMeester score was 39.0 ± 18.5. After TESS, the mean DeMeester score dropped to 15.8 ± 9.2, 13.2 ± 6.8, 11.2 ± 9.4, and 12.0 ± 6.8 on Days 1, 2, 3, and 4, respectively. Conclusion TESS is a safe and potentially effective modality in reducing esophageal-acid exposure in GERD patients unresponsive to standard-dose PPI. A larger and prospective controlled study is needed to verify these preliminary results.
Collapse
Affiliation(s)
- Ram Dickman
- Department of Gastroenterology, Rabin Medical Center, Beilinson Campuses, Petah Tikva and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Sigal Levy
- Statistics Education Unit, Academic College of Tel Aviv-Yafo, Tel Aviv-Yafo, Israel
| | - Tsachi Tsadok Perets
- Department of Gastroenterology, Rabin Medical Center, Beilinson Campuses, Petah Tikva and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Maor Hazani-Pauker
- Department of Gastroenterology, Rabin Medical Center, Beilinson Campuses, Petah Tikva and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Doron Boltin
- Department of Gastroenterology, Rabin Medical Center, Beilinson Campuses, Petah Tikva and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Hemda Schmilovitz-Weiss
- Department of Gastroenterology, Rabin Medical Center, Beilinson Campuses, Petah Tikva and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Issa Nidal
- Department of Surgery B, Rabin Medical Center, Hasharon Campus, Petah Tikva and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Matan Siterman
- Department of Gastroenterology, Rabin Medical Center, Beilinson Campuses, Petah Tikva and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Dan Carter
- Division of Gastroenterology and Hepatology, Chaim Sheba Medical Center, Ramat Gan and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ronnie Fass
- Division of Gastroenterology and Hepatology, Metrohealth Medical Center, Cleveland, OH, USA
| | - Rachel Gingold-Belfer
- Department of Gastroenterology, Rabin Medical Center, Beilinson Campuses, Petah Tikva and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| |
Collapse
|
4
|
Belli S, Prince I, Savio G, Paracchini E, Cattaneo D, Bianchi M, Masocco F, Bellanti MT, Balbi B. Airway Clearance Techniques: The Right Choice for the Right Patient. Front Med (Lausanne) 2021; 8:544826. [PMID: 33634144 PMCID: PMC7902008 DOI: 10.3389/fmed.2021.544826] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2020] [Accepted: 01/14/2021] [Indexed: 12/23/2022] Open
Abstract
The management of bronchial secretions is one of the main problems encountered in a wide spectrum of medical conditions ranging from respiratory disorders, neuromuscular disorders and patients undergoing either thoracic or abdominal surgery. The purpose of this review is illustrate to the reader the different ACTs currently available and the related evidence present in literature. Alongside methods with a strong background behind as postural drainage, manual techniques or PEP systems, the current orientation is increasingly aimed at devices that can mobilize and / or remove secretions. Cough Assist, Vacuum Techniques, systems that modulate airflow have more and more scientific evidence. Different principles combination is a new field of investigation that goes toward an increasing of clinical complexity that will facing us.
Collapse
Affiliation(s)
- Stefano Belli
- Pulmonary Rehabilitation Department, Istituti Clinici Scientifici Maugeri, Istituto di Ricerca e Cura a Carattere Scientifico (IRCCS), Institute of Veruno, Novara, Italy
| | | | | | | | | | | | | | | | | |
Collapse
|
5
|
Rajendran RR, Banerjee A. Effect of Non-Newtonian Dynamics on the Clearance of Mucus From Bifurcating Lung Airway Models. J Biomech Eng 2021; 143:021011. [PMID: 32959056 DOI: 10.1115/1.4048474] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Indexed: 11/08/2022]
Abstract
Mucus hypersecretion is a common pathophysiological manifestation of several obstructive airway diseases in which the mucociliary clearance is impaired, and the airflow generated by a cough or a forced expiratory maneuver called the huff is primarily responsible for clearing mucus. This airflow driven clearance of mucus is a complex process that is affected by the mucus rheology, airflow rate, airway geometry, and gravity. This study examines the role of mucus rheology in the transport and distribution of mucus in idealized 3D airway geometries. The complex air-mucus interface was tracked by the volume-of-fluid (VOF) model, and the turbulence in the core airflow was modeled using the k-ω shear stress transport (SST) model. Mucus was modeled as a shear-thinning liquid by using a power-law model. The computational model was validated using in vitro experimental data available in the literature. Gravity-dominated eccentric core-annular flow was observed with the core biased toward the outer wall in the inclined daughter branches of the bifurcation models, which transitions into concentric core-annular flow in the trachea. The increase in tangential shear at the interface due to the secondary flow structures developed in the flow divider location resulted in a region of enhanced mucus clearance with reduced mucus layer thickness. Secondary flow developed due to the curvature in the airway geometry resulted in a local redistribution of mucus that reduced the eccentricity. The accumulation of mucus around the carinal ridges and the regions with reduced clearance are sites with the potential for microbial growth.
Collapse
Affiliation(s)
- Rahul R Rajendran
- Mem. ASME Department of Mechanical Engineering & Mechanics, Lehigh University, Bethlehem, PA 18015
| | - Arindam Banerjee
- Mem. ASME Department of Mechanical Engineering & Mechanics, Lehigh University, 19 Memorial Drive WestBethlehem, PA 18015
| |
Collapse
|
6
|
Longhini F, Bruni A, Garofalo E, Ronco C, Gusmano A, Cammarota G, Pasin L, Frigerio P, Chiumello D, Navalesi P. Chest physiotherapy improves lung aeration in hypersecretive critically ill patients: a pilot randomized physiological study. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2020; 24:479. [PMID: 32746877 PMCID: PMC7396943 DOI: 10.1186/s13054-020-03198-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Accepted: 07/22/2020] [Indexed: 12/11/2022]
Abstract
Background Besides airway suctioning, patients undergoing invasive mechanical ventilation (iMV) benefit of different combinations of chest physiotherapy techniques, to improve mucus removal. To date, little is known about the clearance effects of oscillating devices on patients with acute respiratory failure undergoing iMV. This study aimed to assess (1) the effects of high-frequency chest wall oscillation (HFCWO) on lung aeration and ventilation distribution, as assessed by electrical impedance tomography (EIT), and (2) the effect of the association of HFCWO with recruitment manoeuvres (RM). Methods Sixty critically ill patients, 30 classified as normosecretive and 30 as hypersecretive, who received ≥ 48 h of iMV, underwent HFCWO; patients from both subgroups were randomized to receive RM or not, according to two separated randomization sequences. We therefore obtained four arms of 15 patients each. After baseline record (T0), HFCWO was applied for 10 min. At the end of the treatment (T1) or after 1 (T2) and 3 h (T3), EIT data were recorded. At the beginning of each step, closed tracheobronchial suctioning was performed. In the RM subgroup, tracheobronchial suctioning was followed by application of 30 cmH2O to the patient’s airway for 30 s. At each step, we assessed the change in end-expiratory lung impedance (ΔEELI) and in tidal impedance variation (ΔTIV), and the center of gravity (COG) through EIT. We also analysed arterial blood gases (ABGs). Results ΔTIV and COG did not differ between normosecretive and hypersecretive patients. Compared to T0, ΔEELI significantly increased in hypersecretive patients at T2 and T3, irrespective of the RM; on the contrary, no differences were observed in normosecretive patients. No differences of ABGs were recorded. Conclusions In hypersecretive patients, HFCWO significantly improved aeration of the dorsal lung region, without affecting ABGs. The application of RM did not provide any further improvements. Trial registration Prospectively registered at the Australian New Zealand Clinical Trial Registry (www.anzctr.org.au; number of registration: ACTRN12615001257550; date of registration: 17th November 2015).
Collapse
Affiliation(s)
- Federico Longhini
- Anesthesia and Intensive Care Unit, Department of Medical and Surgical Sciences, University Hospital Mater Domini, Magna Graecia University, Catanzaro, Italy
| | - Andrea Bruni
- Anesthesia and Intensive Care Unit, Department of Medical and Surgical Sciences, University Hospital Mater Domini, Magna Graecia University, Catanzaro, Italy
| | - Eugenio Garofalo
- Anesthesia and Intensive Care Unit, Department of Medical and Surgical Sciences, University Hospital Mater Domini, Magna Graecia University, Catanzaro, Italy
| | - Chiara Ronco
- Anesthesia and Intensive Care, Sant'Andrea Hospital, ASL VC, Vercelli, Italy
| | - Andrea Gusmano
- Anesthesia and Intensive Care, Sant'Andrea Hospital, ASL VC, Vercelli, Italy
| | - Gianmaria Cammarota
- Department of Anesthesia and Intensive Care, "Maggiore della carità" University Hospital, Novara, Italy
| | - Laura Pasin
- Department of Anesthesia and Intensive Care, Azienda Ospedaliera-Università di Padova, Padua, Italy
| | | | - Davide Chiumello
- SC Anestesia e Rianimazione, Ospedale San Paolo - Polo Universitario, ASST Santi Paolo e Carlo, Milan, Italy.,Dipartimento di Scienze della Salute, Università degli Studi di Milano, Milan, Italy.,Centro Ricerca Coordinata di Insufficienza Respiratoria, Università degli Studi di Milano, Milan, Italy
| | - Paolo Navalesi
- Department of Anesthesia and Intensive Care, Azienda Ospedaliera-Università di Padova, Padua, Italy. .,Dipartimento di Medicina-DIMED, Università degli Studi di Padova, Via Giustiniani, 2 -, 35128, Padova, Italy.
| |
Collapse
|
7
|
Leemans G, Belmans D, Van Holsbeke C, Becker B, Vissers D, Ides K, Verhulst S, Van Hoorenbeeck K. The effectiveness of a mobile high-frequency chest wall oscillation (HFCWO) device for airway clearance. Pediatr Pulmonol 2020; 55:1984-1992. [PMID: 32320537 PMCID: PMC7496233 DOI: 10.1002/ppul.24784] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2019] [Revised: 03/07/2020] [Accepted: 04/11/2020] [Indexed: 12/04/2022]
Abstract
INTRODUCTION High-frequency chest wall oscillation (HFCWO) is a commonly prescribed airway clearance technique (ACT) for patients whose ability to expectorate sputum is compromised. This study aimed to assess the effectiveness of a newly developed mobile ACT device (mHFCWO-The Monarch Airway Clearance System) in patients with cystic fibrosis (CF). A standard nonmobile HFCWO device (sHFCWO) was used as a comparator. METHODOLOGY This was a randomized, open-label, crossover pilot study. CF patients were treated with each device. Sputum was collected during and after each therapy session, while spirometry tests, Brody score assessment and functional respiratory imaging were performed before and after treatments. RESULTS Wet weight of sputum collected during and after treatment was similar for mHFCWO and sHFCWO (6.53 ± 8.55 vs 5.80 ± 5.82; P = .777). Interestingly, the mHFCWO treatment led to a significant decrease in specific airway volume (9.55 ± 9.96 vs 8.74 ± 9.70 mL/L; P < .001), while increasing specific airway resistance (0.10 ± 0.16 vs 0.16 ± 0.23 KPA*S; P < .001). These changes were heterogeneously-distributed throughout the lung tissue and were greater in the distal areas, suggesting a shift of mucus. Changes were accompanied by an overall improvement in the Brody index (57.71 ± 16.55 vs 55.20 ± 16.98; P = .001). CONCLUSION The newly developed mobile device provides airway clearance for CF patients comparable to a nonmobile sHFCWO device, yielding a change in airway geometry and patency by the shift of mucus from the more peripheral regions to the central airways.
Collapse
Affiliation(s)
- Glenn Leemans
- Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | | | | | - Brian Becker
- Department of Medical Affairs, Hillrom Company Inc., St. Paul, Minnesota
| | - Dirk Vissers
- Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Kris Ides
- Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium.,Department of Pediatrics, Antwerp University Hospital, Edegem, Belgium
| | - Stijn Verhulst
- Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium.,Department of Pediatrics, Antwerp University Hospital, Edegem, Belgium
| | - Kim Van Hoorenbeeck
- Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium.,Department of Pediatrics, Antwerp University Hospital, Edegem, Belgium
| |
Collapse
|
8
|
Balañá Corberó A, Admetlló Papiol M, Sancho Muñoz A, Kallouchi M, Badenes D, Rodríguez DA, Martínez-Llorens J. [Effects of high frequency chest wall oscillatory (HFCWO) therapy on gas exchange and ventilation in healthy participants]. Rehabilitacion (Madr) 2020; 55:30-37. [PMID: 32660842 DOI: 10.1016/j.rh.2020.04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Revised: 04/28/2020] [Accepted: 04/30/2020] [Indexed: 10/23/2022]
Abstract
INTRODUCTION Chest physiotherapy is an essential part of the treatment of respiratory diseases with increased respiratory secretion and ineffective cough. To date, there have been no studies on the effect of high frequency chest wall oscillatory (HFCWO) therapy on respiratory muscle strength, ventilation and gas exchange. The aim of this study was therefore to assess these three factors in healthy participants. METHODS Respiratory muscle strength was measured before and immediately after HFCWO therapy in 25 healthy participants. During the treatment, we continuously measured ventilation parameters, gas exchange, oxygen saturation and heart rate. All participants underwent HFCWO sessions twice (with 24hours difference) with the same procedure. Symptoms during the session and discomfort were measured with the visual analog scale (VAS). RESULTS HFCWO therapy produced a change in breathing pattern with increased ventilation associated with altered gas exchange. Heart rate also increased, with no changes in oxygenation. There was no effect, either beneficial or deleterious, on the strength of respiratory muscles. Up to 20% of participants reported substantial discomfort (VAS≥5/10) during the session. CONCLUSIONS This study shows that, during the application of HFCWO therapy in healthy participants, ventilation and heart rate increased. However, there were undesirable effects on gas exchange with a high degree of intolerance among volunteers, with no effects on respiratory muscle strength.
Collapse
Affiliation(s)
- A Balañá Corberó
- Servei de Pneumologia - URMAR, Hospital del Mar - IMIM, Parc de Salut Mar, Barcelona, España.
| | - M Admetlló Papiol
- Servei de Pneumologia - URMAR, Hospital del Mar - IMIM, Parc de Salut Mar, Barcelona, España
| | - A Sancho Muñoz
- Servei de Pneumologia - URMAR, Hospital del Mar - IMIM, Parc de Salut Mar, Barcelona, España
| | - M Kallouchi
- Servei de Pneumologia - URMAR, Hospital del Mar - IMIM, Parc de Salut Mar, Barcelona, España
| | - D Badenes
- Servei de Pneumologia - URMAR, Hospital del Mar - IMIM, Parc de Salut Mar, Barcelona, España
| | - D A Rodríguez
- Servei de Pneumologia - URMAR, Hospital del Mar - IMIM, Parc de Salut Mar, Barcelona, España; CEXS, Universitat Pompeu Fabra, Barcelona, España; CIBER de Enfermedades Respiratorias (CIBERES), ISC III, Madrid, España
| | - J Martínez-Llorens
- Servei de Pneumologia - URMAR, Hospital del Mar - IMIM, Parc de Salut Mar, Barcelona, España; CEXS, Universitat Pompeu Fabra, Barcelona, España
| |
Collapse
|
9
|
Mucus transport and distribution by steady expiration in an idealized airway geometry. Med Eng Phys 2019; 66:26-39. [DOI: 10.1016/j.medengphy.2019.02.006] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2018] [Revised: 12/12/2018] [Accepted: 02/10/2019] [Indexed: 11/17/2022]
|
10
|
Paz C, Suárez E, Vence J, Cabarcos A. Analysis of the volume of fluid (VOF) method for the simulation of the mucus clearance process with CFD. Comput Methods Biomech Biomed Engin 2019; 22:547-566. [PMID: 30773045 DOI: 10.1080/10255842.2019.1569637] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
The clearance of mucus through coughing is a complex, multiphase process, which is affected principally by mucus viscosity and airflow velocity; however, it is also critically affected by the thickness of the two layers of mucus-the serous and gel layers-and oscillation level. The present study examines the effects of the latter parameters more closely. To do so, the mucus clearance process is simulated with a transient 3D volume of fluid (VOF) multiphase model in ANSYS Fluent. The model includes mucus' bilayer properties and a wide range of boundary conditions were tested. The model was analysed in both a straight tube and a realistic trachea. Ultimately, the model was able to both capture air-mucus interface wave evolution and predict the overall behaviour of the clearance process. The results were consistent with experimental clearance data and numerical airflow simulations, which indicates our methodology is appropriate for future studies. Ultimately, the mere presence of the serous layer was found to increase mucus clearance by more than 15 percent. An oscillating flow enhanced clearance by up to 5 percent. Interestingly, interface wave steepness was found to be inversely correlated with mucus thickness, but directly with mucus velocity, which suggests it will be an interesting parameter for further study.
Collapse
Affiliation(s)
- Concepción Paz
- a School of Industrial Engineering , University of Vigo , Vigo , Spain.,b Biofluids Research Group, Galicia Sur Heath Research Institute (IIS Galicia Sur) , SERGAS-UVIGO , Vigo , Spain
| | - Eduardo Suárez
- a School of Industrial Engineering , University of Vigo , Vigo , Spain.,b Biofluids Research Group, Galicia Sur Heath Research Institute (IIS Galicia Sur) , SERGAS-UVIGO , Vigo , Spain
| | - Jesús Vence
- a School of Industrial Engineering , University of Vigo , Vigo , Spain
| | - Adrián Cabarcos
- a School of Industrial Engineering , University of Vigo , Vigo , Spain
| |
Collapse
|
11
|
A new method for enhanced expectoration of sputum by vibratory stimulation of the cervical trachea. Respir Investig 2017; 55:276-282. [PMID: 28705307 DOI: 10.1016/j.resinv.2016.12.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2016] [Revised: 11/19/2016] [Accepted: 12/25/2016] [Indexed: 11/23/2022]
Abstract
BACKGROUND Expectoration of sputum can be difficult for patients with respiratory conditions such as chronic obstructive pulmonary disease, chronic bronchitis, or bronchiectasis because of the effects of decreased pulmonary function, respiratory muscle fatigue, altered sputum properties, and impaired ciliary function. We developed a new method for the vibratory stimulation of the cervical trachea and this study aimed to compare it with the Acapella (a current oscillation device) method. METHODS Patients with chronic productive cough and difficulty with expectoration were recruited for the study. The tracheal vibration and Acapella methods were applied for 4 weeks each, according to a crossover design with an intervening 4-week washout period. To perform the tracheal vibration method, an electronic artificial larynx (Yourtone®) was applied to the cervical trachea for up to 5minutes. Patient preference for the two devices was determined from the performance scores recorded for each device and by using a visual analogue scale. RESULTS Twelve patients were recruited in the study. According to the performance scores assigned by the subjects, the tracheal vibration method was effective in 9 patients, while the Acapella method was effective in 10 patients. Both methods were effective in 8 patients, among whom the tracheal vibration method was more effective in 5 patients. Both methods were found to be ineffective in 1 patient. CONCLUSIONS The tracheal vibration method may be effective at removing central airway sputum and does not require repeated forced expiratory effort, which can otherwise cause exhaustion in patients with decreased lung function. Further investigation is required to confirm its use as a new oscillation technique.
Collapse
|
12
|
Satpathi DK, Ratnam KV, Ramu A. Model for mucus transport in the airways due to air motion — Effect of slipperiness. INT J BIOMATH 2016. [DOI: 10.1142/s1793524516500741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
In this paper, a circular three-layer flow model is proposed to study mucus transport in the airways due to air motion caused by mild forced expiration or mild coughing. Mucus is represented by four-parameter viscoelastic fluid, a combination of Maxwell and Voigt elements, whereas air and serous fluid are taken as Newtonian fluids (incompressible). The pressure gradient generated in the fluid layers is assumed to be given by a time-dependent function representing mild forced expiration or mild cough in the airways causing laminar flow. The effect of slip velocity at the mucus–serous interface caused by the presence of surfactant and at the top surface caused by immotile cilia are also taken into account. The roles of rheological properties of mucus on its transport are studied. The effect of serous fluid and its viscosity on mucus transport is also considered.
Collapse
Affiliation(s)
- Dipak Kumar Satpathi
- Department of Mathematics, Birla Institute of Technology and Science Pilani, Hyderabad Campus Jawahar Nagar Shameerpet, Rangareddy District 500078, India
| | - Kota Venkata Ratnam
- Department of Mathematics, Birla Institute of Technology and Science Pilani, Hyderabad Campus Jawahar Nagar Shameerpet, Rangareddy District 500078, India
| | - Adepalli Ramu
- Department of Mathematics, Birla Institute of Technology and Science Pilani, Hyderabad Campus Jawahar Nagar Shameerpet, Rangareddy District 500078, India
| |
Collapse
|
13
|
Ignagni M, O'Dea T. Mucus clearance from the pulmonary system by mechanical means: a dual-excitation approach. Biomed Instrum Technol 2013; 47:270-274. [PMID: 23692117 DOI: 10.2345/0899-8205-47.3.270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
A dual-excitation approach to mechanical clearance of mucus from the pulmonary system is described. The approach employs independently controlled vibratory and constrictive pressure stimulations to the thorax. Patient cooperative efforts are integrated into the therapy regimen as a means of enhancing the efficacy of the treatment. An engineering model that demonstrates the capability to generate vibratory and constrictive pressure variations at specified levels is described.
Collapse
|
14
|
Jones CU, Kluayhomthong S, Chaisuksant S, Khrisanapant W. Breathing exercise using a new breathing device increases airway secretion clearance in mechanically ventilated patients. Heart Lung 2013; 42:177-82. [PMID: 23474003 DOI: 10.1016/j.hrtlng.2012.12.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2012] [Revised: 12/26/2012] [Accepted: 12/26/2012] [Indexed: 11/25/2022]
Abstract
OBJECTIVES To evaluate the efficacy and safety of a new device (BreatheMAX) that humidifies and oscillates inspired air to increase secretion clearance in mechanically ventilated patients. BACKGROUND Poor secretion clearance is a serious problem for intubated patients leading to lung complications and delayed weaning. METHODS Double blinded crossover; fifteen patients, median age 60 years, range 16-75. Interventions consisted of spontaneous deep breathing with (treatment) and without (sham) humidification and oscillation of inspired air. Airway secretions were aspirated for 3 h before and after each intervention and wet weight and viscosity determined. RESULTS The sham intervention caused no change in secretion clearance (95% CI: -1.8, 1.8 g) but after treatment secretions increased by 4.0 g (95% CI: 1.3, 6.7; p < 0.05). Viscosity decreased 30% after treatment and was unchanged after sham. Changes in cardiopulmonary function were not clinically significant and the patients reported only mild perceptions of breathlessness. CONCLUSIONS Breathing exercise with a device that includes vibration and humidification of inspired air is effective for increasing secretion clearance with patients dependent on mechanical ventilation and was without any adverse effects.
Collapse
Affiliation(s)
- Chulee U Jones
- School of Physical Therapy, Faculty of Associated Medical Sciences, Khon Kaen University, Khon Kaen Province 40002, Thailand.
| | | | | | | |
Collapse
|
15
|
Luthy SK, Marinkovic A, Weiner DJ. Resonant frequency does not predict high-frequency chest compression settings that maximize airflow or volume. Pediatr Pulmonol 2011; 46:604-9. [PMID: 21438176 DOI: 10.1002/ppul.21414] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2010] [Revised: 11/21/2010] [Accepted: 11/22/2010] [Indexed: 11/08/2022]
Abstract
High-frequency chest compression (HFCC) is a therapy for cystic fibrosis (CF). We hypothesized that the resonant frequency (f(res)), as measured by impulse oscillometry, could be used to determine what HFCC vest settings produce maximal airflow or volume in pediatric CF patients. In 45 subjects, we studied: f(res), HFCC vest frequencies that subjects used (f(used)), and the HFCC vest frequencies that generated the greatest volume (f(vol)) and airflow (f(flow)) changes as measured by pneumotachometer. Median f(used) for 32 subjects was 14 Hz (range, 6-30). The rank order of the three most common f(used) was 15 Hz (28%) and 12 Hz (21%); three frequencies tied for third: 10, 11, and 14 Hz (5% each). Median f(res) for 43 subjects was 20.30 Hz (range, 7.85-33.65). Nineteen subjects underwent vest-tuning to determine f(vol) and f(flow). Median f(vol) was 8 Hz (range, 6-30). The rank order of the three most common f(vol) was: 8 Hz (42%), 6 Hz (32%), and 10 Hz (21%). Median f(flow) was 26 Hz (range, 8-30). The rank order of the three most common f(flow) was: 30 Hz (26%) and 28 Hz (21%); three frequencies tied for third: 8, 14, and 18 Hz (11% each). There was no correlation between f(used) and f(flow) (r(2) = -0.12) or f(vol) (r(2) = 0.031). There was no correlation between f(res) and f(flow) (r(2) = 0.19) or f(vol) (r(2) = 0.023). Multivariable analysis showed no independent variables were predictive of f(flow) or f(vol). Vest-tuning may be required to optimize clinical utility of HFCC. Multiple HFCC frequencies may need to be used to incorporate f(flow) and f(vol).
Collapse
Affiliation(s)
- Sarah K Luthy
- Department of Pediatric Pulmonology, Children's Hospital of Pittsburgh of UPMC, Pittsburgh, Pennsylvania 15201, USA
| | | | | |
Collapse
|
16
|
Sontag MK, Quittner AL, Modi AC, Koenig JM, Giles D, Oermann CM, Konstan MW, Castile R, Accurso FJ. Lessons learned from a randomized trial of airway secretion clearance techniques in cystic fibrosis. Pediatr Pulmonol 2010; 45:291-300. [PMID: 20146387 PMCID: PMC4163837 DOI: 10.1002/ppul.21179] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
RATIONALE Airway secretion clearance therapies are a cornerstone of cystic fibrosis care, however longitudinal comparative studies are rare. Our objectives were to compare three therapies [postural drainage and percussion: (postural drainage), flutter device (FD), and high frequency chest wall oscillation: (vest)], by studying (1) change in pulmonary function; (2) time to need for intravenous (IV) antibiotics, (3) use of pulmonary therapies, (4) adherence to treatment, (5) treatment satisfaction, and (6) quality of life. METHODS Participants were randomly assigned to one of three therapies twice daily. Clinical outcomes were assessed quarterly over 3 years. RESULTS Enrollment goals were not met, and withdrawal rates were high, especially in postural drainage (51%) and FD (26%), compared to vest (9%), resulting in early termination. FEV(1) decline, time to need IV antibiotics, and other pulmonary therapies were not different. The annual FEF(25-75%) predicted rate of decline was greater in those using vest (P = 0.02). Adherence was not significantly different (P = 0.09). Overall treatment satisfaction was higher in vest and FD than in postural drainage (P < 0.05). Health-related quality of life was not different. The rate of FEV(1) decline was 1.23% predicted/year. CONCLUSIONS The study was ended early due to dropout and smaller than expected decline in FEV(1). Patients were more satisfied with vest and FD. The longitudinal decline in FEF(25-75%) was faster in vest; we found no other difference in lung function decline, taken together this warrants further study. The slow decline in FEV(1) illustrates the difficulty with FEV(1) decline as a clinical trial outcome.
Collapse
Affiliation(s)
- Marci K Sontag
- Department of Epidemiology, Colorado School of Public Health, University of Colorado Denver, 13001 E 17th, Box B119, Aurora, CO 80045, USA.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
17
|
Ragavan AJ, Evrensel CA, Krumpe P. Interactions of Airflow Oscillation, Tracheal Inclination, and Mucus Elasticity Significantly Improve Simulated Cough Clearance. Chest 2010; 137:355-61. [DOI: 10.1378/chest.08-2096] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
|
18
|
Improving mucociliary clearance in chronic obstructive pulmonary disease. Respir Med 2008; 103:496-502. [PMID: 19091536 DOI: 10.1016/j.rmed.2008.10.014] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2008] [Revised: 10/12/2008] [Accepted: 10/16/2008] [Indexed: 11/24/2022]
Abstract
Patients with COPD usually experience mucus hypersecretion as a result of airway inflammation and response to noxious stimuli. These in turn lead to worsening airway resistance, impaired airflow, increased work of breathing, dyspnoea and exercise intolerance. Mucus hypersecretion may also lead to increased exacerbations and poor health related quality of life (HRQL). Institution based pulmonary rehabilitation programs incorporating airway clearance techniques have been shown to improve HRQL, reduce dyspnoea and improve exercise tolerance but are often difficult to provide due to restricted accessibility and resource implications. This review examines the current evidence base and best clinical practice in the area of airway clearance. Mechanical devices such as the flutter valves, positive end expiratory pressure and high frequency chest wall oscillation (HFCWO) may be able to provide the benefits of improved airway clearance in the patient's home potentially with reduced demands on healthcare resources.
Collapse
|
19
|
Lee YW, Lee J, Warwick WJ. Waveforms of high-frequency chest compression systems change with jacket, body. Biomed Instrum Technol 2008; 42:407-411. [PMID: 18925824 DOI: 10.2345/0899-8205(2008)42[407:wohccs]2.0.co;2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Affiliation(s)
- Yong W Lee
- Minnesota Cystic Fibrosis Center, Department of Pediatrics, University of Minnesota Medical School, Minneapolis, MN, USA
| | | | | |
Collapse
|
20
|
Abstract
High-frequency chest compression (HFCC) is shown to enhance clearance of pulmonary airway secretions. Several HFCC devices have been designed to provide this therapy. Standard equipment consists of an air pulse generator attached by lengths of tubing to an adjustable, inflatable vest/jacket (V/J) garment. In this study, the V/Js were fitted over a mannequin. The three device air pulse generators produced characteristic waveform patterns. The variations in the frequency and pressure setting of devices were consistent with specific device design features. These studies suggest that a better understanding of the effects of different waveform, frequency, and pressure combinations may improve HFCC therapeutic efficacy of three different HFCC machines. The V/J component of HFCC devices delivers the compressive pulses to the chest wall to produce both airflow through and oscillatory effects in the airways. The V/J pressures of three HFCC machines were measured and analyzed to characterize the frequency, pressure, and waveform patterns generated by each of three device models. The dimensions of all V/Js were adjusted to a circumference of approximately 110% of the chest circumference. The V/J pressures were measured, and maximum, minimum, and mean pressure, pulse pressure, and root mean square of three pulse generators were calculated. Jacket pressures ranged between 2 and 34 mmHg. The 103 and 104 models' pulse pressures increased with the increase in HFCC frequency at constant dial pressure. With the ICS the pulse pressure decreased when the frequency increased. The waveforms of models 103 and 104 were symmetric sine wave and asymmetric sine wave patterns, respectively. The ICS had a triangular waveform. At 20 Hz, both the 103 and 104 were symmetric sine waveform but the ICS remained triangular. Maximum crest factors emerged in low-frequency and high-pressure settings for the ICS and in the high-frequency and low-pressure settings for models 103 and 104. Recognizing the significant differences in frequency and pressure amplitude may help clinicians and patients optimize the efficacy of HFCC therapy. Evidence-based therapeutic guidelines are needed.
Collapse
Affiliation(s)
- Yong W Lee
- Department of electrical engineering, University of Minnesota, Minneapolis, MN 55455, USA
| | | | | |
Collapse
|
21
|
Gregson RK, Stocks J, Petley GW, Shannon H, Warner JO, Jagannathan R, Main E. Simultaneous measurement of force and respiratory profiles during chest physiotherapy in ventilated children. Physiol Meas 2007; 28:1017-28. [PMID: 17827650 DOI: 10.1088/0967-3334/28/9/004] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
There are currently no objective means of quantifying chest wall vibrations during manual physiotherapy. The aims of the study were to (i) develop a method to quantify physiotherapy-applied forces and simultaneous changes in respiratory flow and pressure, (ii) assess the feasibility of using this method in ventilated children and (iii) characterize treatment profiles delivered by physiotherapists in the paediatric intensive care unit. Customized sensing mats were designed and used in combination with a respiratory profile monitor. Software was developed to align force and flow data streams. Force and respiratory data were successfully collected in 55 children (median age 1.6 years (range 0.02-13.7 years)). Physiotherapists demonstrated distinctive variations in the pattern of force applied and manual lung inflations. The maximum applied force ranged from 15 to 172 N, and was correlated with the child's age (r = 0.76). Peak expiratory flow increased significantly during manual inflations both with and without chest wall vibrations (p < 0.05). This method provides the basis for objective assessments of the direct and independent effects of vibration forces and manual lung inflations as an essential precursor to developing evidence-based practice.
Collapse
Affiliation(s)
- R K Gregson
- Child Health, University of Southampton with Southampton University Hospitals NHS Trust, SO16 6YD, UK.
| | | | | | | | | | | | | |
Collapse
|
22
|
Milla CE, Hansen LG, Warwick WJ. Different frequencies should be prescribed for different high frequency chest compression machines. Biomed Instrum Technol 2007; 40:319-24. [PMID: 16941931 DOI: 10.2345/i0899-8205-40-4-319.1] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
High frequency chest compression (HFCC) is used for treatment and prevention of the lung diseases characterized by impaired mucus clearance and/or cough, where patients are at risk for acquiring acute bronchitis or pneumonia. The HFCC treatment frequencies may be prescribed according to the manufacturers' generic guidelines or may be determined for each individual patient by a "tuning" method that measures, at the mouth, the air volume displacement and the associated airflows produced at each frequency. Tuning is performed while the patient is breathing normally during the HFCC system operation. After measurements for several breaths at one frequency have been collected, the program randomly selects and measures another frequency until the entire frequency range of the machine being tuned has been sampled. Frequencies range from 6 to 21 Hz for the sine waveform machines and from 6 to 25 Hz for the square waveform machines. Each group of flow signals is digitized and analyzed by the program. For each frequency, the HFCC flow velocities and volumes are computed and averaged. These average flows and volumes are rank ordered; the three frequencies with the highest flows and the three frequencies producing the largest volumes are selected for prescription. If the same frequency is selected as one of the three best frequencies for both flow and volume, the next ranked frequency is selected randomly for flow or volume. Significant differences exist between patients and HFCC machines. In a series of 100 cystic fibrosis (CF) patients with varying degrees of lung disease, we found that the best-ranked frequencies varied from patient to patient and did not correlate with patients' age, gender, height, weight, or spirometry parameters. With the sine waveform, the highest HFCC airflows were between 13 and 20 Hz 82% of the time and the largest HFCC volumes were between 6 and 10 Hz 83% of the time. With the square waveform, both the highest average HFCC flow rates and the largest volume average HFCC displacements were between 6 and 14 Hz. Nevertheless, in this sample of 100 consecutive tunings, every frequency from 6 and 20 Hz was a best frequency for at least one patient. These findings provide the basis for recommending a tuning protocol to be used for prescribing frequencies with the various HFCC machines, because they are different from one another. If a patient's tuning cannot be done, it may be useful to prescribe the best frequencies based on the waveform machine he or she uses.
Collapse
Affiliation(s)
- Carlos E Milla
- University of Minnesota Cystic Fibrosis Center, Minneapolis, MN, USA
| | | | | |
Collapse
|
23
|
Stites SW, Perry GV, Peddicord T, Cox G, McMillan C, Becker B. Effect of high-frequency chest wall oscillation on the central and peripheral distribution of aerosolized diethylene triamine penta-acetic acid as compared to standard chest physiotherapy in cystic fibrosis. Chest 2006; 129:712-7. [PMID: 16537872 DOI: 10.1378/chest.129.3.712] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND AND OBJECTIVES High-frequency chest wall oscillation (HFCWO) has been shown to be as effective as standard chest physiotherapy (SCPT) for removal of pulmonary secretions as well as increasing FEV(1) in cystic fibrosis (CF) patients. Patients using HFCWO often administer aerosolized medications simultaneously, reducing time required for daily care. While peripheral pulmonary distribution of tracer in normal subjects has been shown to be unaffected by HFCWO, this has not been studied in CF patients. We evaluated distribution of aerosolized (99m)Tc diethylene triamine penta-acetic acid (DTPA) administered simultaneously with HFCWO and compared this with DTPA aerosolized after SCPT. STUDY DESIGN Ten CF patients, ages 22 to 38 years, with moderate-to-severe obstructive disease were studied in a crossover design after documentation of stable lung function. (133)Xe was administered to delineate total lung volume. DTPA was aerosolized (Pari LC Plus nebulizer and Pulmo-Aide compressor; Pari Respiratory Equipment Inc.; Richmond, VA) to delineate airway deposition. The central to peripheral deposition ratio (C/P ratio) of each lung was analyzed in each study group. Central regions were represented by the inner one third of the (133)Xe scan as demonstrated in previous research models. RESULTS The mean C/P ratio (+/- SD) for both lungs was 1.45 +/- 0.31 with HFCWO and 1.46 +/- 0.28 following SCPT (p = not significant [NS]). Right lung mean C/P ratio was 1.74 +/- 0.43 with HFCWO and 1.85 +/- 0.63 after SCPT (p = NS). Left lung mean C/P ratio was 1.25 +/- 0.29 with HFCWO and 1.21 +/- 0.35 after SCPT (p = NS). There was no correlation between C/P ratio and FEV(1) or FVC. CONCLUSIONS Use of HFCWO in combination with aerosolized DTPA did not result in increased central deposition as compared with aerosolized DTPA administered after SCPT. Further study is required to determine if combining HFCWO with aerosolized medications can be modified to improve peripheral deposition.
Collapse
Affiliation(s)
- Steven W Stites
- Division of Pulmonary and Critical Care Medicine, University of Kansas Medical Center, Mail Stop 3007, Kansas City, KS 66160, USA.
| | | | | | | | | | | |
Collapse
|
24
|
Giarraffa P, Berger KI, Chaikin AA, Axelrod FB, Davey C, Becker B. Assessing Efficacy of High-Frequency Chest Wall Oscillation in Patients With Familial Dysautonomia. Chest 2005; 128:3377-81. [PMID: 16304287 DOI: 10.1378/chest.128.5.3377] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
STUDY OBJECTIVE To determine the benefits of daily use of high-frequency chest wall oscillation (HFCWO) in familial dysautonomia (FD) patients with lung disease. DESIGN Pulmonary function tests, chest radiographs, and blood tests were performed on entry to the study. A retrospective chart review of 12 months prior to entry provided baseline data regarding respiratory illnesses, medications, doctor visits, hospitalizations, and absenteeism. Daily logs provided prospective data on these parameters as well as HFCWO usage. Evaluations were performed at 1, 3, 6, 9, and 12 months for pulse oximetry, spirometry, and log review. At the exit evaluation, blood tests and chest radiographs were repeated. PATIENTS Fifteen FD patients with history of lung disease requiring daily inhalation therapy (7 female and 8 male; age range, 11 to 33 years) were enrolled in a 1-year clinical trial of HFCWO therapy. Two subjects withdrew after 3 months and 6 months, respectively. Each individual served as his/her own control. RESULTS Oxygen saturation improved by 1 month (median, 97.5%; interquartile range [IQR], 96 to 98%; vs median, 94%; IQR, 89 to 96%) and was sustained at exit evaluation (median, 98%; IQR, 98 to 98%) [p = 0.004]. Median FVC and peak expiratory flow rate (PEFR) were the pulmonary function measures with sustained improvement from baseline to exit (p = 0.02 and p = 0.03, respectively). When retrospective and prospective data were compared, all measured health outcomes improved significantly, including pneumonias (p = 0.0156), hospitalizations (p = 0.0161), antibiotic courses (p = 0.0005), antibiotic days (p = 0.0002), doctor visits (p = 0.0005), and absenteeism (p = 0.0002). CONCLUSION In this limited study of FD patients, HFCWO effected significant improvements in all measured health outcomes and oxygen saturation; FVC and PEFR were the pulmonary function measures demonstrating sustained improvement.
Collapse
Affiliation(s)
- Philip Giarraffa
- Dysautonomia Center, New York University Medical Center, New York University School Medicine, NY, USA
| | | | | | | | | | | |
Collapse
|
25
|
Wong WP, Paratz JD, Wilson K, Burns YR. Hemodynamic and ventilatory effects of manual respiratory physiotherapy techniques of chest clapping, vibration, and shaking in an animal model. J Appl Physiol (1985) 2003; 95:991-8. [PMID: 12754172 DOI: 10.1152/japplphysiol.00249.2003] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Chest clapping, vibration, and shaking were studied in 10 physiotherapists who applied these techniques on an anesthetized animal model. Hemodynamic variables (such as heart rate, blood pressure, pulmonary artery pressure, and right atrial pressure) were measured during the application of these techniques to verify claims of adverse events. In addition, expired tidal volume and peak expiratory flow rate were measured to ascertain effects of these techniques. Physiotherapists in this study applied chest clapping at a rate of 6.2 +/- 0.9 Hz, vibration at 10.5 +/- 2.3 Hz, and shaking at 6.2 +/- 2.3 Hz. With the use of these rates, esophageal pressure swings of 8.8 +/- 5.0, 0.7 +/- 0.3, and 1.4 +/- 0.7 mmHg resulted from clapping, vibration, and shaking respectively. Variability in rates and "forces" generated by these techniques was <20% in average coefficients of variation. In addition, clinical experience accounted for 76% of the variance in vibration rate (P = 0.001). Cardiopulmonary physiotherapy experience and layers of towel used explained approximately 79% of the variance in clapping force (P = 0.004), whereas age and clinical experience explained >80% of variance in shaking force (P = 0.003). Application of these techniques by physiotherapists was found to have no significant effects on hemodynamic and most ventilatory variables in this study. From this study, we conclude that chest clapping, vibration, and shaking 1). can be consistently performed by physiotherapists; 2). are significantly related to physiotherapists' characteristics, particularly clinical experience; and 3). caused no significant hemodynamic effects.
Collapse
Affiliation(s)
- W P Wong
- Department of Physiotherapy, Singapore General Hospital, Singapore 169608.
| | | | | | | |
Collapse
|
26
|
O'Hare R, Loan PB, Crean P, Doyle M, Shaw P, Ryan T. The effect of varying resistance or compliance on the movement of liquid during high frequency oscillation. Paediatr Anaesth 2000; 10:692-3. [PMID: 11119221 DOI: 10.1111/j.1460-9592.2000.ab01j.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- R O'Hare
- Paediatric Intensive Care Unit, Royal Belfast Hospital for Sick Children, Northern Ireland
| | | | | | | | | | | |
Collapse
|
27
|
Scherer TA, Barandun J, Martinez E, Wanner A, Rubin EM. Effect of high-frequency oral airway and chest wall oscillation and conventional chest physical therapy on expectoration in patients with stable cystic fibrosis. Chest 1998; 113:1019-27. [PMID: 9554641 DOI: 10.1378/chest.113.4.1019] [Citation(s) in RCA: 44] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
STUDY OBJECTIVE To compare the effect of high-frequency oral airway oscillation, high-frequency chest wall oscillation, and conventional chest physical therapy (CPT) on weight of expectorated sputum, pulmonary function, and oxygen saturation in outpatients with stable cystic fibrosis (CF). DESIGN Prospective randomized trial. SETTING Pediatric pulmonary division of a tertiary care center. PATIENTS Fourteen outpatients with stable CF recruited from the CF center. INTERVENTIONS Two modes of oral airway oscillation (1: frequency 8 Hz; inspiratory to expiratory [I:E] ratio 9:1; 2: frequency 14 Hz; I:E ratio 8:1), two modes of chest wall oscillation (1: frequency 3 Hz; I:E ratio 4:1; 2: frequency 16 Hz; I:E ratio 1:1, alternating with frequency 1.5 Hz, I:E ratio 6:1), and CPT (clapping, vibration, postural drainage, and encouraged coughing) were applied during the first 20 min of 4 consecutive hours. MEASUREMENTS AND RESULTS Sputum was collected on an hourly basis for a total of 6 consecutive hours. During the first and the last hour, patients collected sputum without having any treatment and underwent pulmonary function tests (PFTs). Oxygen saturation was measured at 30-min intervals during hours 1 to 6. For the first 20 min of the second to the fifth hour, patients received one of the treatments. To assess the effect of the intervention, the weight of expectorated sputum during hours 2 to 6 was averaged and expressed as percentage of the weight expectorated during the first hour (baseline). For the five treatment modalities, mean sputum dry and wet weights ranged between 122% and 185% of baseline. There was no statistically significant difference among the treatment modalities. As measured by sputum wet weight, all oscillatory devices tended to be less effective than CPT (p=0.15). As measured by dry weight, oral airway oscillation at 8 Hz with an I:E ratio of 9:1 and CPT tended to be more effective than the other treatment modalities (p=0.57). None of the treatment modalities had an effect on PFTs and oxygen saturation and all were well tolerated. CONCLUSION In outpatients with stable CF, high-frequency oscillation applied via the airway opening or via the chest wall and CPT have comparable augmenting effects on expectorated sputum weight without changing PFTs or oxygen saturation. In contrast to CPT, high-frequency oral airway and chest wall oscillations are self-administered, thereby containing health-care expenses.
Collapse
Affiliation(s)
- T A Scherer
- Division of Pulmonary Diseases, University of Miami School of Medicine, USA
| | | | | | | | | |
Collapse
|
28
|
Patrinos ME, Balaraman V, Ku T, Meister J, Rubin BK, Stenzler A, Easa D. Promoting meconium clearance from the lungs of the neonatal piglet with asymmetric high frequency oscillation. Pediatr Res 1997; 42:342-7. [PMID: 9284275 DOI: 10.1203/00006450-199709000-00015] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
To investigate the role of high frequency oscillation (HFO) in promoting meconium clearance from the airway, we used a commercially available ventilator configured with maximal expiratory flow exceeding inspiratory flow (asymmetric HFO or AHFO). We hypothesized that AHFO would move meconium in an expiratory direction (toward the ventilator). We first tested our hypothesis in vitro and, later, in vivo using the neonatal piglet. In vitro experiments using a Plexiglas airway confirmed meconium movement in an expiratory direction when bias ratio was > or = 2. For in vivo experiments, each piglet received a 3 mL/kg intratracheal bolus of a 44 g/100 mL meconium mixture followed by 45 min of mechanical ventilation. Then, in part 1, the piglet was placed in a 15 degree head down tilt position and randomized to either AHFO [ratio of inspiratory time/expiratory time (I:E) of 70:30] or HFO (I:E ratio of 30:70). After 30 min of either AHFO or HFO, the piglet was crossed over to the alternate strategy for an additional 30 min. For part 2, we maintained the piglet on either AHFO or HFO continuously for 4 h. Results demonstrate that, although there was a tendency for larger volumes of meconium to be aspirated from the airway during AHFO in part 1 experiments, there was no difference found in part 2. We also found no significant differences in blood gases or hemodynamic measurements between AHFO and HFO during the prolonged observation period in part 2 of our study. We conclude that AHFO is of no benefit in the treatment of meconium aspiration syndrome.
Collapse
Affiliation(s)
- M E Patrinos
- Department of Pediatrics, Kapiolani Medical Center for Women and Children and John A. Burns School of Medicine, University of Hawaii, Honolulu 96826, USA
| | | | | | | | | | | | | |
Collapse
|
29
|
van der Schans CP, Goldstein RS, Bach JR. Airway Secretion Management and Oxygen Therapy. Phys Med Rehabil Clin N Am 1996. [DOI: 10.1016/s1047-9651(18)30397-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
|
30
|
|
31
|
Hansen LG, Warwick WJ, Hansen KL. Mucus transport mechanisms in relation to the effect of high frequency chest compression (HFCC) on mucus clearance. Pediatr Pulmonol 1994; 17:113-8. [PMID: 8165037 DOI: 10.1002/ppul.1950170207] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
High frequency chest compression (HFCC) appears promising as a form of chest physiotherapy. Studies published by several clinical centers support its efficacy, and further clinical data are expected to become available.
Collapse
Affiliation(s)
- L G Hansen
- University of Minnesota Medical School, Minneapolis 55455
| | | | | |
Collapse
|
32
|
Nagase T, Fukuchi Y, Shimizu T, Matsuse T, Orimo H. Reduction of 15-hydroxyeicosatetraenoic acid (15-HETE) in tracheal fluid by high frequency oscillatory ventilation. Prostaglandins Leukot Essent Fatty Acids 1990; 40:177-80. [PMID: 2402521 DOI: 10.1016/0952-3278(90)90095-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
The effects of high frequency oscillatory ventilation (HFOV) and conventional mechanical ventilation (CMV) on tracheal secretion were compared in 6 anesthetized dogs. Using a double-balloon endotracheal catheter, 5 ml of saline was instilled into an isolated tracheal segment during HFOV and CMV for 10 min respectively. Two eicosanoids, 15-hydroxyeicosatetraenoic acid (15-HETE) and 11-dehydrothromboxane B2 (11-dehydro-TXB2) were measured by radioimmunoassay in each sample. HFOV (stroke volume: 6 ml/kg, f: 10 Hz, bias flow: 5 l/min) and CMV (stroke volume: 12 ml/kg, f: 15/min) were performed in random sequence and achieved comparable gas exchange. The concentration of 15-HETE in tracheal fluid during HFOV (87 +/- 67 pg/ml) was decreased to less than half of that during CMV (286 +/- 184 pg/ml, P less than 0.05), while there was no significant change of 11-dehydro-TXB2 either in tracheal fluid or in plasma. This reduction of 15-HETE was tended to be enhanced by vagotomy (HFOV: 42 +/- 14, CMV: 120 +/- 103 pg/ml) with the concentration ratio of CMV/HFOV remaining unchanged. HFOV may provide hitherto unrecognized advantage over CMV by reducing airway secretion of 15-HETE, a potent inflammatory mediator.
Collapse
Affiliation(s)
- T Nagase
- Department of Geriatrics, Faculty of Medicine, University of Tokyo, Japan
| | | | | | | | | |
Collapse
|