Active cycle of breathing technique versus oscillating PEP therapy versus walking with huffing during an acute exacerbation of bronchiectasis: a randomised, controlled trial protocol

Vibroacoustic therapy in the treatment of patients with COVID-19 complicated by respiratory failure: a pilot randomized controlled trial

Introduction

Coronavirus infection is a dangerous airborne disease that can lead to serious lung damage. Data on the effectiveness of low-frequency chest vibrations in the treatment of lung diseases are available; however, not so many of them exist. Vibroacoustic pulmonary therapy is a component of physiotherapy that improves lung perfusion and drainage without requiring active patient participation. This study aimed to increase statistical efficiency through maximizing the relevant information obtained from the clinical data. Calculating the sample size to determine the power of subsequent studies was also necessary.

Research methods

A pilot randomized parallel trial involving 60 patients was conducted. The patients were divided into two equal groups, where they received sessions of vibroacoustic pulmonary therapy using the "VibroLung" device in two modes "acute respiratory distress syndrome (ARDS)" and "Pneumonia," with identical treatment. The patients were > 18 years old with detected COVID-19 by PCR and grade 2 and 3 lung lesions detected by computer tomography (CT). Blood sampling was performed in the morning at the same time before and after the hardware massage to determine PaO2, PaCO2, and P/F.

Results

As a result of the test, the following data were obtained: on the first day in the group using the "ARDS" mode, PaO2 indicators averaged 65, CI 95% [58.6-73.2] and on average 77.5, CI 95% [69.8-85.2], "before" and "after," respectively, which indicates improved oxygenation after the procedure. However, in the second group with the "Pneumonia" mode after its use, PaCO2 was higher after the session, on average 48.7, CI 95% [40.8-56.6], whereas before that, the following indicators had, on average 43.6, CI 95% [37.2-50].

Conclusion

Thus, the data obtained yielded ambiguous results, which are the basis for further study in future randomized controlled trials. As the treatment of coronavirus infection has no etiological treatment, even small shifts in the therapy of this category of patients can be significant.

Clinical trial registration

ClinicalTrials.gov, identifier NCT05143372.

[The use of oscillatory respiratory therapy with positive expiratory pressure (PEP-therapy) to restore the functional state of the lungs in patients after cardiac surgery]

Postoperative pulmonary complications in cardiac surgery patients occur in 10-35% of cases, depending on differences in their definition, patient characteristics and type of surgical intervention, most of them are associated with ineffective coughing and evacuation of bronchial secretions.

OBJECTIVE

To determine the effectiveness of stimulating the evacuation of bronchial secretions with the help of oscillating PEP therapy carried out during the first three days.

MATERIAL AND METHODS

A randomized prospective study of 60 adult patients after elective cardiac surgery was performed (Clinical Trials.gov. protocol number NCT05159401). Oscillatory PEP-therapy was performed in 30 patients using Acapella DHGreen device (SmithMedicalASD, USA) 10-12 hours after tracheal extubation 3 times a day for 3 days after surgery. The control group (30 patients). The inclusion criteria: age over 18 years, spontaneous breathing after tracheal extubation, clear consciousness and productive contact with the patient, the ability to maintain adequate gas exchange on the low-flow oxygen inhalation, adequate analgesia (<2 points of VAS). Exclusion criteria: the need for re-intubation and mechanical ventilation, non-invasive mask ventilation, high-flow oxygen therapy, acute cerebrovascular accident, ongoing bleeding, cardiac insufficiency (inotropic index >10), shocks syndrome of various etiologies, the use of any extracorporeal support, any neuromuscular disorders, pneumothorax, hydro-or hemothorax. Before each session and 20 minutes after its end, when breathing air, blood oxygen saturation was recorded using a pulse oximeter (SpO2), the maximum inspiratory capacity (MIC) was measured using a Coach-2 incentive spirometer from SmithsMedical and spirometry with a portable ultrasonic spirometer Spiro Scout (Schiller, Switzerland). For the purposes of this work, the total index of the spirometry maximum inspiratory capacity (SMIC) was used - the sum of the respiratory volume and the reserve volume of inspiration in ml.

RESULTS

Difficulties in evacuation of sputum were noted in 90% of patients. Three-day sessions of oscillating PEP- therapy are accompanied by a significant improvement in the passage of sputum, as evidenced by a 3-fold increase in the number of patients with productive cough. The increase in MIC in the main group was 46.9% and 21.3%, respectively (p=0.042), and the number of patients with values greater than MICo. 1500 ml increased from 23.3% to 7.6% (p<0.001). The effectiveness of oscillatory PEP-therapy is confirmed by a 7-fold decrease in the frequency of radiological changes in the lungs at the end of sessions (p<0.001), while in the control group the frequency of their occurrence practically did not change and remained at a high level. The total number of patients with respiratory insufficiency (SpO2≤92%) decreased by 8.6 times after completion of all PEP- therapy sessions (p=0.001), however, without statistically significant difference with the control group.

CONCLUSIONS

Oscillatory PEP- therapy in cardiac surgery patients has a positive effect on sputum passage, ventilation parameters and oxygenating lung function. The procedure was well tolerated and there were no complications associated with it.