Data is everything – Clinical Evaluations of HFCWO & MI/E Airway Clearance Systems
HFCWO and MI-E Insufflation Exsufflation Airway Clearance Studies indicate that both HFCWO & MI/E Airway Clearance Systems are safe and effective medical devices. The underlying treatment principles are important and effective tools in the treatment of many respiratory conditions. Below are links to peer-reviewed, clinical research studies of various different airway clearance systems that prove their efficacy.
High-Frequency Chest Wall Oscillation (HFCWO) for Cystic Fibrosis
This was a study using the Hill-Rom Monarch Vest indicating that refinements of the HFCWO technique have made it more effective. Using higher pressure and variable frequency settings led to patients coughing up more mucus from the lungs. Some manufacturers are adding “targeted kinetic energy” devices to their vests to help mobilize mucus.
High-frequency chest wall compression therapy in neurologically impaired children
Forty-five percent of the subjects required hospital admission before initiation of HFCWC therapy. This rate decreased to 36% after the first year with HFCWC, and to 13% after the second year with HFCWC. There was a statistically significant reduction of the number of hospital days at follow-up, relative to before treatment. Use of an assisted-cough device or the presence of tracheostomy did not significantly affect hospitalization days. CONCLUSIONS: Regular HFCWC therapy may reduce the number of hospitalizations in neurologically impaired children. Based on this data, Medafore.com recommends the Hill-Rom Vest Model 105 as well as the RespirTech inCourage system for some pediatric patients.
High-Frequency Chest-Wall Compression During the 48 Hours Following Thoracic Surgery
No major adverse events were encountered. Hemodynamic and pulse oximetry values remained stable before, during, and after HFCWC. Eighty-four percent of the subjects reported little or no discomfort during therapy. In addition, subjects who expressed a preference preferred HFCWC to conventional chest physiotherapy by more than two to one. Researchers concluded that HFCWC is a safe, well-tolerated adjunct after thoracic surgery. The observation of hemodynamic stability is especially important, considering that the patients were studied in the early postoperative period, during epidural analgesia.
Ten children with NMD (seven spinal muscular atrophy, two Duchenne muscular dystrophy and one centronuclear myopathy) using MI-E at home were identified. MI-E use commenced at mean age of 8.5 years (range 1.1-16.9) with 1.4 years of use (range 0.3-3.8). MI-E pressures ranged from +/-30 to 40 cmH2 O with no complications reported. There was a significant reduction in hospital days at 6 (P = 0.036) and 12 (P = 0.028) months following commencement of home MI-E compared with the same period preceding MI-E use. The survey highlighted positive benefits of MI-E use, in particular the ability to treat many pulmonary exacerbations at home. Home MI-E use by children with NMD can reduce hospitalization and benefit families by maintaining their child at home.
Airway Clearance Techniques for Mechanically Ventilated Patients: Insights for Optimization
Secretion management in mechanically ventilated patients is a paramount task for clinicians. A better understanding of the mechanisms of flow bias and airway dynamic compression during airway clearance therapy may enable a more effective approach for this population.
The use of HFCWC induced similar clinical effects as airway clearance techniques and was safe for non-hospitalized infants with AVB. Both techniques reduced respiratory symptoms and acutely improved. (ClinicalTrials.gov: NCT03835936.) Based on the results of this study, Medafore.com recommends the Hill-Rom Vest Model 105 as well as the RespirTech inCourage system for some infant patients.
Airway Clearance With an Optimized Mechanical Insufflation-Exsufflation Maneuver
The optimized MI-E maneuver, applied with slow insufflation, resulted in a higher expiratory flow bias, which made the therapy more effective at moving mucus outward, compared with the standard MI-E maneuver, typically applied with fast insufflation. Therefore, Medafore recommends the use of the CoughAssist T70 for certain respiratory patients.
NCFB patients showed improved self-reported outcomes associated with the initiation of HFCWO therapy as measured by number of hospitalizations, antibiotic use, and the subjective experience of airway clearance. The improvement was observed early on after initiation of therapy and sustained for at least 1 year.
The HFCWO technique provides an improvement both in pulmonary function and quality of life related parameters in patients with chronic hypersecretive disease. Since those patients need daily airway clearance, this treatment should be included among the principal options in chest physiotherapy. The study was registered as ChiCTR-TRC-12002134 at http://www.chictr.org.
Total medical costs, hospitalizations, and pneumonia claims were less after than before initiation of HFCWO in a broad group of patients with neuromuscular disease. Subject to the limitations that administrative data did not capture how HFCWO was used and that HFCWO may be a marker of generally better care, our findings lend support to the routine use of this intervention in the care of patients with neuromuscular diseases.
The longitudinal study shows that high frequency chest wall oscillation (“HFCWO”) therapy an Airway Clearance System significantly reduces bronchiectasis-related exacerbations including the need for antibiotics, emergency department visits and hospitalizations, and that this effectiveness was maintained for 2.5 years after the initiation of treatment.