Practices for High Frequency Chest Compression in Children

Abstract

Background: High frequency chest compression (HFCC) is an airway clearance method used for treatment of cystic fibrosis (CF). It is frequently utilized in other diagnoses such as non-CF bronchiectasis, neuromuscular disease, severe neurological impairment, or other conditions with increased airway secretions. Consensus for HFCC session duration and device settings is available for CF but not other diagnoses. The aim of this study is to describe the use of HFCC in children’s hospitals.

Methods: Acute care children’s hospitals in the US who were members of the Children’s Hospital Association at the time of the study were invited to participate in a survey about HFCC practices used at their institution. Respiratory department directors, managers or supervisors were contacted by email to complete an electronic questionnaire. Responses were collected in the Research Electronic Data Capture database. Survey domains included diagnoses in which HFCC is used, session duration, device settings, frequency of therapy, and concomitant inhaled medication use. Descriptive statistics were used to analyze collected data.

Results: Of the 198 invitations sent, 16% (31/198) were returned for unknown address, resulting in 167 invited institutions. The response rate was 19% (31/167). The regional location of participating institutions was Midwest (14), South (10), West (4) and Northeast (3). Three institutions (10%, 3/31) stated HFCC is not used and did not proceed to the survey. The majority of institutions that completed the survey were free-standing hospitals (71%, 20/28) and most did not have a pediatric pulmonary fellowship program (61%, 17/28). The median HFCC session duration for CF was 30 min and 20 min for all other diagnoses. The use of 10 and 15 Hz were the most common settings for all diagnoses. Short-acting bronchodilators were utilized by all institutions before or during HFCC for one or more diagnoses. Frequency of HFCC therapy for inpatient treatment of pulmonary exacerbation was 4 times a day for all diagnoses most of the time: CF 75% (21/28), non-CF bronchiectasis 71% (20/28), severe neurological impairment 64% (18/28), and NMD 61% (17/28).

Conclusions: Practices for HFCC use vary among US children’s hospitals. More research is needed to establish best practices and evidence-based guidelines for HFCC session duration, device settings, and concomitant inhaled medications, especially in non-CF diagnoses.