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Research ArticleOriginal Research

Comparison of Settings Used for High-Frequency Chest-Wall Compression in Cystic Fibrosis

Robert R Kempainen, Carlos Milla, Jordan Dunitz, Kay Savik, Ann Hazelwood, Cynthia Williams, Bruce K Rubin and Joanne L Billings
Respiratory Care June 2010, 55 (6) 695-701;
Robert R Kempainen
Minnesota Cystic Fibrosis Center, Department of Medicine, University of Minnesota School of Medicine, Minneapolis, Minnesota.
MD
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  • For correspondence: [email protected]
Carlos Milla
Center for Excellence in Pulmonary Biology, Stanford University School of Medicine, Palo Alto, California.
MD
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Jordan Dunitz
Minnesota Cystic Fibrosis Center, Department of Medicine, University of Minnesota School of Medicine, Minneapolis, Minnesota.
MD
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Kay Savik
School of Nursing, University of Minnesota, Minneapolis, Minnesota.
MSc
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Ann Hazelwood
Minnesota Cystic Fibrosis Center, Department of Medicine, University of Minnesota School of Medicine, Minneapolis, Minnesota.
CRT
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Cynthia Williams
Minnesota Cystic Fibrosis Center, Department of Medicine, University of Minnesota School of Medicine, Minneapolis, Minnesota.
CRT CRC
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Bruce K Rubin
Department of Pediatrics, Virginia Commonwealth University School of Medicine, Richmond, Virginia.
MEngr, MD MBA
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Joanne L Billings
Minnesota Cystic Fibrosis Center, Department of Medicine, University of Minnesota School of Medicine, Minneapolis, Minnesota.
MD
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Abstract

BACKGROUND: Cystic fibrosis (CF) patients commonly use a high-frequency chest-wall compression (HFCWC) device for airway clearance that generates oscillatory flow with a sine-wave configuration. Typical HFCWC settings combine a lower Vest inflation pressure setting (eg, 5 on the Vest's arbitrary 1–10 scale for the setting that controls the background pressure of the inflatable vest) with mid-range frequency (14–16 Hz) (lower-pressure/mid-frequency HFCWC).

OBJECTIVE: To determine whether HFCWC with higher pressure settings (6–10 on the Hill-Rom Vest's arbitrary 1–10 scale) combined with variable mid-frequencies (8, 9, and 10 Hz, plus 18, 19, and 20 Hz) (higher-pressure/variable-frequency HFCWC) results in greater sputum expectoration than lower-pressure/mid-frequency HFCWC.

METHODS: This was a controlled randomized crossover study. Sixteen clinically stable, adult CF patients participated. Patients performed airway clearance with HFCWC, once each with lower-pressure/mid-frequency HFCWC and higher-pressure/variable-frequency HFCWC, on separate occasions. All sputum produced during each session was collected. Patients completed pulmonary function tests before and after each session.

RESULTS: Median sputum wet weight was greater with higher-pressure/variable-frequency HFCWC than with lower-pressure/mid-frequency HFCWC (6.4 g, range 0.49–22.0 g, versus 4.8 g, range 0.24–15.0 g, P = .02). Dry sputum weight differences did not reach statistical significance (higher-pressure/variable-frequency HFCWC 0.20 g, range 0.009–0.62 g, lower-pressure/mid-frequency HFCWC 0.12 g, range 0.0001–1.0 g, P = .23). Higher-pressure/variable-frequency HFCWC and lower-pressure/mid-frequency HFCWC resulted in similar increases in FEV1 (70 mL vs 90 mL, P = .21) and forced vital capacity (80 mL vs 80 mL, P = .94). Post-therapy sputum viscoelastic properties did not differ. Patients perceived the 2 regimens as equally comfortable and effective (P = .35 and P = .35, respectively).

CONCLUSIONS: In adult CF patients, single-session higher-pressure/variable-frequency HFCWC resulted in greater sputum expectoration by wet weight, but not other differences, compared to the commonly used lower-pressure/mid-frequency settings. Longer-term comparisons are needed in a larger, more diverse population to determine whether sustained use of the higher-pressure/variable-frequency settings results in clinically important differences in outcomes. (Clinicaltrials.gov registration NCT00685035).

  • high-frequency chest wall compression
  • HFCWC
  • cystic fibrosis
  • airway-clearance techniques
  • bronchial drainage

Footnotes

  • Correspondence: Robert R Kempainen MD, Department of Medicine, Hennepin County Medical Center, University of Minnesota School of Medicine, Mail Stop G-5, 701 Park Avenue, Minneapolis MN 55415. E-mail: kempa001{at}umn.edu.
  • This research was partly supported by Hill-Rom, and by grant M01-RR00400 from the National Center for Research Resources of the National Institutes of Health. The authors have disclosed no other conflicts of interest.

  • See the Related Editorial on Page 782

  • Copyright © 2010 by Daedalus Enterprises Inc.
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Respiratory Care: 55 (6)
Respiratory Care
Vol. 55, Issue 6
1 Jun 2010
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Comparison of Settings Used for High-Frequency Chest-Wall Compression in Cystic Fibrosis
Robert R Kempainen, Carlos Milla, Jordan Dunitz, Kay Savik, Ann Hazelwood, Cynthia Williams, Bruce K Rubin, Joanne L Billings
Respiratory Care Jun 2010, 55 (6) 695-701;

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Comparison of Settings Used for High-Frequency Chest-Wall Compression in Cystic Fibrosis
Robert R Kempainen, Carlos Milla, Jordan Dunitz, Kay Savik, Ann Hazelwood, Cynthia Williams, Bruce K Rubin, Joanne L Billings
Respiratory Care Jun 2010, 55 (6) 695-701;
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  • high-frequency chest wall compression
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  • cystic fibrosis
  • airway-clearance techniques
  • bronchial drainage

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