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HFCWO and The Vest® Airway Clearance System
Studies: Long-Term Home Care Airway Clearance Patients
Article Citation
Warwick WJ, Hansen L. The long-term
effect of high-frequency chest
compression therapy on pulmonary
complications of cystic fibrosis. Pediatr
Pulmonol 1991; 11: 265-271.
Type of Study
Retrospective
Self-controlled
Number (n) &
Type of Subjects
16 cystic fibrosis
patients
Protocol
• Daily HFCC for 30-minute sessions of 5-minute periods at 6 different frequencies
• Therapy time ranged from 30-240 minutes in 1-4
treatments/day for a mean of 21.6 months (range = 7-26
months)
• Results compared with pre-HFCC CPT administered 1-4x/day
for a mean of 23.2 months (range = 14-27 months)
• Coughing and huffing techniques employed
Anbar RD, Powell KN, Iannuzzi DM.
Short-term effect of ThAIRapy Vest on
pulmonary function of cystic fibrosis
patients. Am J Respir Crit Care Med 1998;
157 (suppl 3): A 130
Retrospective
Self-controlled
54 cystic fibrosis
patients
Results
• 94% of patients' regression line slopes became more
positive during self-administered HFCC therapy as
compared to slopes calculated from pulmonary
function scores obtained before HFCC was substituted
for CPT
• The Vest® System associated with sustained or
improved PFTs in 15 of 16 subjects
• No treatment-associated adverse events observed
• Daily HFCWO administered for an average of 19 ± 13 minutes
for at least 6 months
• Improvement in FEV1 of patients who had performed
CPT prior to switching to The Vest® System was 7%
• Results compared with best pre-HFCWO PFTs from previous
0-6 months
• Improvement in patients who did not use CPT prior
to beginning therapy with The Vest® System was 11%
• HFCWO therapy with The Vest® System improved lung
function of all subjects in the short term regardless of
prior use of CPT
• No treatment-associated adverse events observed
Giarraffa P, Berger K, Chaikin A, Axelrod F,
Davey C, Becker B. Assessing Efficacy of
High Frequency Chest Wall Oscillation in
Patients with Familial Dysautonomia.
Chest 2005; 128:3377-3381.
Retrospectiveprospective
self-controlled
15 familial
dysautonomia
patients
• Twice daily HFCWO for 20 to 30 minute sessions
• Pulmonary function tests, chest radiograph and blood tests at
study entrance
• Retrospective chart review 12 months prior to entry provided
baseline data for respiratory illnesses, medications, doctor
visits, hospitalizations, and absenteeism
• Daily log recording of prospective data for same parameters
and HFCWO treatment adherence
• HFCWO was associated with significant improvements
in the following measured outcomes:
o
o
o
o
o
o
Pneumonias (p = 0.0156)
Hospitalizations (p = 0.0161)
Antibiotic courses (p = 0.0005)
Antibiotic days (p = 0.0002)
Doctor visits (p = 0.0005)
Absenteeism (p = 0.0002)
• Evaluations at 1, 3, 6, 9, and 12 months for pulse oximetry,
spirometry and log review
• Exit blood tests and chest radiographs
Landon C, Goldie W, Evans JR. Airway
Clearance Therapy utilizing High
Frequency Chest Wall Oscillation for medically fragile children. Unpublished clinical
study data, 2001.
Retrospective
prospective
15 medically
complex children
(MCC)
15 MCC who had been treated with daily CPT received The Vest®
System Therapy for at least 12 months
After at least 12 months of The Vest® System,
15 medically complex children showed an aggregate…
• The Vest® System Therapy 2x daily for 15-20 minutes at 15 Hz
and pressure settings of 5-6
• Three-fold reduction in total hospital days (21 days
with The Vest® System vs. 66 days pre-HFCWO)
• Prospective data for total days hospitalized and total ICU days
compared with retrospective
• The elimination of ICU days (0 days with The Vest®
System vs. 34 days pre-HFCWO)
• 90% tolerance
• No treatment-associated adverse events observed
Hill-Rom
HFCWO and The Vest® Airway Clearance System
Studies: Long-Term Home Care Airway Clearance Patients
Article Citation
Plioplys AV, Lewis S, Kasnicka I. Pulmonary
vest therapy in quadriplegic cerebral palsy.
J Am Med Dir Assoc 2002; 3: 318-321.
Type of Study
Retrospectiveprospective
self-controlled
Number (n) &
Type of Subjects
7 quadriplegic
cerebral palsy
patients with
lung disease
Protocol
• 12 month prospective daily therapy with The Vest® System
• Twelve month retrospective clinical data collected from
nursing records maintained daily according to residential
facility protocol provided baseline data for CPT therapy
schedules, pneumonias, hospitalizations, seizures, and
effective suctioning
• Twelve month prospective data collected for same parameters
during therapy with The Vest® System
Results
• Clinical outcomes after 12 months of The Vest®
System Therapy showed:
Pneumonias (n)
Hospitalizations (n)
Seizures (n)
Effective
suctioning (n)
Before VT
During VT
P value*
36
18
P = 0.026
9
3
P = 0.160
267
43
P = 0.125
4,825
10,455
P = 0.008
• No reports of significant adverse events
Subjects randomized and then crossed over to receive either
• No episodes of bronchospasm occurred
in 13 asthmatic subjects receiving HFCWO
Wen AS, Woo MS, Keens TG. Safety
of chest physiotherapy in asthma.
Am J Respir Crit Care Med 1996;
153 (Suppl): A 77.
Randomized,
Crossover,
Controlled
13 asthmatic patients
Ndukwu, IM, Shapiro S, Nam AJ, Schumm
PL. Comparison of High Frequency Chest
Wall Oscillation (HFCWO) and manual
chest physiotherapy (mCPT) in long-term
acute care hospital (LTAC) ventilatordependent patients. Chest 1999; 116 (4)
Suppl 2: 311S.
Randomized,
Controlled
54 ventilatordependent
individuals
hospitalized in
a long-term acute
care facility
Subjects ventilated for a median of 84 days were assigned to
receive either
• After 21 days, patients randomized to HFCWO had
cleared greater volumes of sputum (p = 0.114)
• manual chest physiotherapy (mCPT)
• High Frequency Chest Wall Oscillation (HFCWO) via The Vest®
Airway Clearance System
• mCPT: 15 minutes, 4 times a day for 40 days
• HFCWO: 15 minutes, 4 times a day for 40 days
• After 40 days, HFCWO patients experienced a more
than two-fold greater rate of successful weaning from
the ventilator: 10/26 vs. 4/28 (p = 0.063)
J David Rhodes, Nancy V Lemons, Della J
Coupland, Sean C Orr, Rodney D Soto,
Camilo R Gomez, Univ of AlabamaBirmingham, Birmingham, AL.
Simultaneous Application of Vibrating
Vest and Cough Assist Device Improve
Respiratory Function in Stroke Patient.
Presented at the 28th International Stroke
Conference, Phoenix, AZ. 2003. [Abstract
ID: 100980; PubNumber: P322]
Prospective
10 stroke patients
10 acute stroke patients were treated with either a combination
of The Vest® Airway Clearance System Therapy and a mechanical
cough-assisting device or CPT for at least 3 days.
• The Vest® Airway Clearance System/cough assist
patients showed significant improvement in:
• All patients received nebulized bronchodilators every 4 hours
• Pulmonary function measures before and after each
treatment using bedside spirometry
• Analysis of variance (ANOVA) used to compare effects of each
treatment
• Minute ventilations (Ve) [p = 0.02]
• Nebulized bronchodilator (NB) treatment
• NB plus HFCWO on different days
• PFTs measured before and after a nebulized bronchodilator
treatment
• PFTs measured before and after 30 minutes of HFCC administered with a nebulized bronchodilator treatment
• PFTs include FEV1, RV/TLC, Raw, SGaw, PETC02, SP02
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• Forced vital capacity (FVC) [p = 0.0001]
• The Vest® Airway Clearance System/cough assist
patients showed a positive trend in SpO2 [p = 0.08]