Objective Measurement of Adherence to Out-Patient Airway Clearance Therapy by High-Frequency Chest Wall Compression in Cystic Fibrosis.

BACKGROUND: Objective measures of adherence to high-frequency chest wall compression (HFCWC), a form of airway clearance therapy for patients with cystic fibrosis, are lacking. We used a novel electronic monitoring device integrated into an HFCWC vest to measure adherence compared with self-reported adherence. We determined factors that influenced adherence and how adherence correlated with baseline pulmonary function and pulmonary exacerbations. METHODS: Data were collected by direct measurement of date, time of day, and duration of HFCWC use to determine the number of daily treatments and daily duration of treatments. Chart review provided prescribed airway clearance therapy treatment and demographic and clinical information. Subject and caregiver report of the daily number of airway clearance therapy treatments was obtained by telephone interviews. Analysis used 2-sample and paired t test, analysis of variance, and linear regression. RESULTS: Average adherence was 69%. Adherence was highest in children (82%, P = .02) and those receiving assistance with treatment (82%, P < .001). Subjects overestimated therapy duration from a mean ± SD of 127 ± 169% by adults to 19.2 ± 26.3% by parents or guardians of children. Average adherence decreased with increasing prescribed therapy time (P = .02). Average daily therapy time and adherence had significant positive associations with baseline FEV1 percent of predicted (P = .02 and P = .02, respectively) and negative associations with pulmonary exacerbations during the pre-study period and at baseline (P = .044 and P = .02, respectively). CONCLUSIONS: Greater adherence to HFCWC measured directly by a novel recorder was associated with better baseline pulmonary function and fewer exacerbations in the pre-study and baseline period. Adherence decreased with age and prescribed therapy time and increased with therapy assistance. Self-report overestimation is large and thus not an accurate measure of adherence.

The impact of re-education of airway clearance techniques (REACT) on adherence and pulmonary function in patients with cystic fibrosis.

BACKGROUND: Our centre's median forced expiratory volume in one second (FEV1) reported in the 2005 Cystic Fibrosis (CF) Foundation Patient Registry was below the national median. The focus of our quality improvement initiative was to improve lung function through re-education of airway clearance techniques (REACT). AIM: The global aim was to improve the median FEV1 in our patients. The specific aim was to encourage adherence to airway clearance techniques (ACT). To achieve these goals we implemented the REACT programme for patients. METHODS: Educational sessions introduced the concept of improving clinical outcomes and the importance of airway clearance in achieving optimal lung function. The REACT programme utilised an anonymous survey, in-clinic questionnaire and ACT demonstration to assess knowledge, practices and barriers to ACT. Patients were then categorised as non-adherent or adherent with correct or incorrect technique. Improper techniques were corrected. All patients were re-educated on the rationale for ACT. RESULTS: Our surveys revealed that 43% of patients had barriers to ACT and 53% were non-adherent. Following implementation of REACT, median FEV1 increased from 84% to 92% (national median 91-94%) from 2005 to 2010 for patients aged 6-17. For patients 18 and older, median FEV1 increased from 56% to 64% (national median 62-65%) from 2005 to 2010. CONCLUSIONS: By introducing a programme focused on technique and adherence, we were able to improve median FEV1 in patients with CF. Sustained improvement of FEV1 was accomplished by continued use of the REACT programme.

[Postural therapy during mechanical pulmonary ventilation with PEEP in patients with unilateral lung damage]. / Pozitsionnaia terapiia pri mekhanicheskoi ventiliatsii legkikh s PDKV u bol'nykh s odnostoronnim povrezhdeniem legkikh.

Mechanical ventilation of the lungs (MVL) with positive end expiratory pressure (PEEP) is difficult in patients with unilateral lung damage because of uneven distribution of volumes and pressures in the involved and intact lungs. Harmful effects are easier manifested under such conditions. Selective MVL with selective PEEP is widely used abroad for optimizing MVL, but this method is rather expensive and is not devoid of shortcomings. Our study carried out in 32 patients with unilateral lung involvement showed that traditional MVL with general PEEP can effectively (in 75% cases) regulate gaseous exchange and decrease its untoward effects if MVL is performed with the patient lying on the healthy side and not supine. MVL in patients with unilateral lung injury lying on the healthy side can be a simpler and cheaper alternative to selective MVL with selective PEEP.

Continuous oscillation therapy improves the pulmonary outcome of intubated newborns: results of a prospective, randomized, controlled trial.

OBJECTIVES: To determine the effects of continuous postural changes produced by an oscillating bed on cardiopulmonary function and on the duration of endotracheal intubation and oxygen supplementation with large premature and term infants. DESIGN: A prospective, randomized, controlled trial. SETTING: Neonatal intensive care unit. PATIENTS: Nineteen 1-day-old newborns weighing > 1500 g with various respiratory diseases. INTERVENTIONS: The treatment group received continuous postural therapy on an oscillating bed; the control group received conventional frequency of manual postural changes. Both groups received physiotherapy. Patients were studied until they were extubated and oxygen supplementation was stopped. MEASUREMENTS AND MAIN RESULTS: Selected cardiopulmonary variables and ventilator settings during the first 6 hrs of study and the overall duration of endotracheal intubation and oxygen supplementation were determined. Oscillation therapy significantly decreased the duration of oxygen supplementation and had no adverse effects on cardiopulmonary variables. In a subgroup of infants with respiratory distress syndrome from prematurity or asphyxia, oscillation therapy also significantly shortened the duration of oxygen supplementation; a trend toward reduced duration of intubation was observed. CONCLUSIONS: Continuous postural changes using an oscillating bed reduced the duration of oxygen supplementation in infants with various respiratory disorders. Furthermore, this oscillation therapy was not associated with adverse cardiopulmonary or thermal complications.