Different frequencies should be prescribed for different high frequency chest compression machines.

High frequency chest compression (HFCC) is used for treatment and prevention of the lung diseases characterized by impaired mucus clearance and/or cough, where patients are at risk for acquiring acute bronchitis or pneumonia. The HFCC treatment frequencies may be prescribed according to the manufacturers' generic guidelines or may be determined for each individual patient by a "tuning" method that measures, at the mouth, the air volume displacement and the associated airflows produced at each frequency. Tuning is performed while the patient is breathing normally during the HFCC system operation. After measurements for several breaths at one frequency have been collected, the program randomly selects and measures another frequency until the entire frequency range of the machine being tuned has been sampled. Frequencies range from 6 to 21 Hz for the sine waveform machines and from 6 to 25 Hz for the square waveform machines. Each group of flow signals is digitized and analyzed by the program. For each frequency, the HFCC flow velocities and volumes are computed and averaged. These average flows and volumes are rank ordered; the three frequencies with the highest flows and the three frequencies producing the largest volumes are selected for prescription. If the same frequency is selected as one of the three best frequencies for both flow and volume, the next ranked frequency is selected randomly for flow or volume. Significant differences exist between patients and HFCC machines. In a series of 100 cystic fibrosis (CF) patients with varying degrees of lung disease, we found that the best-ranked frequencies varied from patient to patient and did not correlate with patients' age, gender, height, weight, or spirometry parameters. With the sine waveform, the highest HFCC airflows were between 13 and 20 Hz 82% of the time and the largest HFCC volumes were between 6 and 10 Hz 83% of the time. With the square waveform, both the highest average HFCC flow rates and the largest volume average HFCC displacements were between 6 and 14 Hz. Nevertheless, in this sample of 100 consecutive tunings, every frequency from 6 and 20 Hz was a best frequency for at least one patient. These findings provide the basis for recommending a tuning protocol to be used for prescribing frequencies with the various HFCC machines, because they are different from one another. If a patient's tuning cannot be done, it may be useful to prescribe the best frequencies based on the waveform machine he or she uses.

High-frequency chest compression: effect of the third generation compression waveform.

High-frequency chest compression (HFCC) therapy has become the prevailing form of airway clearance for patients with cystic fibrosis (CF) in the United States. The original square waveform was replaced in 1995 with a sine waveform without published evidence of an equality of effectiveness. The recent development of a triangle waveform for HFCC provided the opportunity to compare the functional and therapeutic effects of different waveforms. Clinical testing was done in patients at home with therapy times recorded with all sputum collected in preweighed sealable vials. The eight study patients with CF were regular users of a sine waveform device. They produced sputum consistently and were clinically stable. They used their optimum frequencies for therapy for each waveform and, for one week for each waveform, collected all sputum during their twice-daily timed HFCC therapies. After collection, these vials were reweighed, desiccated, and reweighed to calculate wet and dry weights of sputum per minute of therapy time. Frequency associated vest pressures transmitted to the mouth, and induced airflows at the mouth were measured in healthy volunteers. The pressure waveforms produced in the vest were, in shape, faithfully demonstrable at the mouth. In the healthy subject the transmission occurred in 2 ms and was attenuated to about 75% of the vest pressure for the triangle waveform and 60% for the sine waveform. All patients produced more sputum with the triangle waveform than with the sine waveform. The mean increase was 20%+ range of 4% to 41%. P value was <.001. Future studies of HFCC should investigate the other effects of the sine and triangle waveforms, as well as the neglected square waveform, on mucus clearance and determine the best frequencies for each waveform, disease, and patient.

Detecting changes in respiratory patterns in high frequency chest compression therapy by single-channel blind source separation.

High Frequency Chest Compression (HFCC) is used as a method to remove the mucus in the airway for Cystic Fibrosis (CF) patients. As the characteristics of the tracheal sound reflect the conditions of airways, in this paper, we propose a novel method to evaluate the respiratory patterns in HFCC therapy by using single channel tracheal sounds only. The difficulty of analyzing tracheal sounds lies in that it has a wider frequency band than the air flow at the mouth, and is always corrupted by other biomedical signals and noises. During HFCC therapy, the tracheal sound is also affected by the HFCC machine noise. For this reason, it is difficult to extract respiratory patterns and other related features by traditional filtering techniques. In this paper, we demonstrate use of single-channel independent component analysis to extract respiratory patterns from the tracheal sounds before, during and after HFCC therapy, and use basis features in the tracheal sound to detect the change in respiratory patterns.

Induced respiratory system modeling by high frequency chest compression using lumped system identification method.

High frequency chest compression (HFCC) treatment systems are used to promote mucus transport and mitigate pulmonary system clearance problems to remove sputum from the airways in patients with Cystic Fibrosis (CF) and at risk of developing chronic obstructive pulmonary disease (COPD). Every HFCC system consists of a pump generator, one or two hoses connected to a vest, to deliver the pulsation. There are three different waveforms in use; symmetric sine, the asymmetric sine and the trapezoid waveforms. There have been few studies that compared the efficacy of a sine waveform with the HFCC pulsations. In this study we present a model of the respiratory system for a young normal subject who is one of co-authors. The input signal is the pressure applied by the vest to chest, at a frequency of 6Hz. Using the system model simulation, the effectiveness of different source waveforms is evaluated and compared by observing the waveform response associated with air flow at the mouth. Also the study demonstrated that the ideal rectangle wave produced the maximum peak air flow, and followed by the trapezoid, triangle and sine waveform. The study suggests that a pulmonary system evaluation or modeling effort for CF patient might be useful as a method to optimize frequency and waveform structure choices for HFCC therapeutic intervention.

Two models of high frequency chest compression therapy: interaction of jacket pressure and mouth airflow.

High frequency chest compression (HFCC) therapy assists clearing the secretions in the lung. This paper presents two mathematical models: 1) HFCC jacket function model (JFM) and 2) respiratory function model (RFM). JFM predicts the variation of the jacket pressure (Pj) from the respiratory pattern of mouth airflow (Fm). RFM predicts the HFCC induced mouth airflow (Fm) from the HFCC pulse pressures at the jacket (Pj). Fm and Pj were measured from a healthy subject during HFCC therapy. JFM, which was implemented with 2nd order system using prediction error method, shows the existence of breathing pattern at Pj. RFM, which was implemented with amplitude modulation technique, shows how the HFCC pulses affects to the Fm. JFM calculations match 78% of the measured respiratory pattern of Pj>. RFM calculations match 90% of measured HFCC induced Fm. These models can be used to test new breathing patterns before designing studies on patients having chronic obstructive pulmonary diseases.