Effectiveness of a new "focused pulse" high-frequency chest wall oscillation in patients with moderate to severe COPD.

BACKGROUND: Chest physiotherapy plays a crucial role in the treatment of COPD, although the optimal techniques for airway clearance have not been definitively established. Among the different techniques, high-frequency chest wall oscillation (HFCWO) has gained attention for its potential to create a widespread lung percussion, facilitating the removal of secretions and potentially clearing the peripheral bronchial tree. This study aims to assess the effectiveness of a novel "focused pulse" HFCWO in patients with moderate to severe COPD. METHODS: Sixty patients were randomized to three groups: a group treated with the PEP technique, a group with "focused pulse "HFCWO" and a group with pharmacological therapy alone (control group). The primary outcomes were changes in respiratory function parameters, changes in dyspnea and quality of life scores as well as daily life activity and health status assessment. The secondary outcomes were the number of exacerbations and the number of practitioner or emergency department (ED) visits after 1, 3, and 6 months. RESULTS: Sixty patients concluded the study with 20 patients allocated to each group. The two devices improved respiratory function tests, quality of life and health scores and dyspnea compared to the control group. Maximal expiratory pressure and diffusing lung carbon oxide were significantly improved in the focused pulse HFCWO group compared to the PEP group. Only pulse-focused HFCWO showed a statistically significant lower number of exacerbations and visits to ED or practitioner compared to the control group. CONCLUSIONS: The focused pulse HFCWO technique improves daily life activities and lung function in patients with stable COPD. The device demonstrated significantly greater effectiveness in lowering COPD exacerbations as well as visits to ED or practitioner.

CT-FEM of the human thorax: Frequency response function and 3D harmonic analysis at resonance.

BACKGROUND AND OBJECTIVE: High-frequency chest wall compression (HFCC) therapy by airway clearance devices (ACDs) acts on the rheological properties of bronchial mucus to assist in clearing pulmonary secretions. Investigating low-frequency vibrations on the human thorax through numerical simulations is critical to ensure consistency and repeatability of studies by reducing extreme variability in body measurements across individuals. This study aims to present the numerical investigation of the harmonic acoustic excitation of ACDs on the human chest as a gentle and effective HFCC therapy. METHODS: Four software programs were sequentially used to visualize medical images, decrease the number of surfaces, generate and repair meshes, and conduct numerical analysis, respectively. The developed methodology supplied the validation of the effect of HFCC through computed tomography-based finite element analysis (CT-FEM) of a human thorax. To illustrate the vibroacoustic characteristics of the HFCC therapy device, a 146-decibel sound pressure level (dBSPL) was applied on the back-chest surface of the model. Frequency response function (FRF) across 5-100 Hz was analyzed to characterize the behaviour of the human thorax with the state-space model. RESULTS: We discovered that FRF pertaining to accelerance equals 0.138 m/s2N at the peak frequency of 28 Hz, which is consistent with two independent experimental airway clearance studies reported in the literature. The state-space model assessed two apparent resonance frequencies at 28 Hz and 41 Hz for the human thorax. The total displacement, kinetic energy density, and elastic strain energy density were furthermore quantified at 1 µm, 5.2 µJ/m3, and 140.7 µJ/m3, respectively, at the resonance frequency. In order to deepen our understanding of the impact on internal organs, the model underwent simulations in both the time domain and frequency domain for a comprehensive analysis. CONCLUSION: Overall, the present study enabled determining and validating FRF of the human thorax to roll out the inconsistencies, contributing to the health of individuals with investigating gentle but effective HFCC therapy conditions with ACDs. This innovative finding furthermore provides greater clarity and a tangible understanding of the subject by simulating the responses of CT-FEM of the human thorax and internal organs at resonance.

La disfunción de las pequeñas vías aéreas deteriora la calidad de vida de fumadores sin limitación al flujo aéreo / Small Airway Dysfunction Impairs Quality of Life Among Smokers With No Airflow Limitation

Introducción: La disfunción de las pequeñas vías aéreas (DPV) inducida por el tabaco contribuye precozmente a la patogenia de la limitación al flujo aéreo (LFA), aunque resulta poco conocida su repercusión en la percepción de salud. Se pretende evaluar la frecuencia de DPV en fumadores activos sin LFA y comparar la calidad de vida relacionada con la salud (CVRS) de no fumadores, fumadores sin DPV, fumadores con DPV y fumadores con LFA. Métodos: En 53 fumadores activos sin LFA, 20 fumadores con LFA y 20 no fumadores, se utilizaron los cuestionarios SF-36 y EuroQoL y se realizó oscilometría de impulsos, espirometría y determinación de las densidades de atenuación del parénquima pulmonar en inspiración y espiración máximas. Se consideró que existía DPV cuando la resistencia a 5 Hz (R5), la diferencia R5-R20 y el área de reactancia (AX) excedían su límite superior de la normalidad. Resultados: El 35,8% de los fumadores sin LFA tenía DPV. No se detectaron diferencias en los parámetros espirométricos ni la atenuación pulmonar entre los fumadores con o sin DPV y los no fumadores. Sin embargo, los fumadores con DPV presentaban una peor puntuación en los cuestionarios de CVRS que los fumadores sin DPV o los no fumadores, e intermedia a los fumadores con LFA. R5 y X5 fueron identificados como determinantes independientes de la CVRS en los fumadores sin LFA. Conclusiones: La DPV es frecuente en fumadores sin LFA, afectando a un tercio de los mismos, y condicionando de forma independiente su percepción de salud

Introduction: Small airway dysfunction (SAD) caused by smoking contributes to the early onset of airflow limitation (AFL), although its impact on patients’ perception of health is largely unknown. We aimed to evaluate the frequency of SAD in active smokers without AFL, and to compare health-related quality of life (HRQoL) of non-smokers, smokers without SAD, smokers with SAD, and smokers with AFL. Methods: A total of 53 active smokers without AFL, 20 smokers with AFL, and 20 non-smokers completed the SF-36 and EuroQoL questionnaires and performed impulse oscillometry and spirometry. Pulmonary parenchymal attenuation was determined in inspiration and expiration. SAD was determined to exist when resistance at 5Hz (R5), the difference between R5 and R20, and reactance area (AX) exceeded the upper limit of normal. Results: In total, 35.8% of smokers without AFL had SAD. No differences were detected in spirometric parameters or pulmonary attenuation between smokers with or without AFL and non-smokers. However, smokers with SAD had worse scores on HRQoL questionnaires than smokers without SAD or non-smokers, and scores compared to smokers with AFL were intermediate. R5 and X5 were identified as independent determinants of HRQoL in smokers without AFL. Conclusions: SAD is common in smokers without AFL, affecting one third of this population, and independently affecting their perception of health

Effects of manual chest compression and descompression maneuver on lung volumes, capnography and pulse oximetry in patients receiving mechanical ventilation / Efeitos da manobra de compressão e descompressão torácica nos volumes pulmonares, capnografia e oximetria de pulso em pacientes submetidos à ventilação mecânica

OBJECTIVES: The aims of this study were to evaluate whether there are changes in lung volumes, capnography, pulse oximetry and hemodynamic parameters associated with manual chest compression-decompression maneuver (MCCD) in patients undergoing mechanical ventilation (MV). Method: A prospective study of 65 patients undergoing to MV after 24 hours. All patients received bronchial hygiene maneuvers and after 30 minutes they were submitted to ten repetitions of the MCCD during 10 consecutive respiratory cycles in the right hemithorax and than in the left hemithorax. The data were collected before the application of the maneuver and after 1, 5, 10, 15, 20, 25, 30, 35 and 40 minutes following application of the maneuver. RESULTS: There were statistical significant (p<0.0001) improvements in the following parameters after MCCD maneuver during all phases of data collection until 40 minutes: inspiratory tidal volume (baseline: 458.2±132.1 ml; post 1 min: 557.3±139.1; post 40 min: 574.4±151), minute volume (baseline: 7.0±2.7 L/min; post 1 min: 8.7±3.3; post 40 min: 8.8±3.8), and pulse oximetry (baseline: 97.4±2.2%; post 1 min: 97.9±1,8; post 40 min: 98.2±1.6; p<0.05). There was a reduction in CO2 expired (baseline: 35.1±9.0 mmHg; post 1 min: 31.5±8.2; post 40 min: 31.5±8.29; p<0.0001). There was no statically significant changes in heart rate (baseline: 94.5±20.5 mmHg; post 1 min: 94.7±20.5; post 40 min: 94.92±20.20; p=1) and mean arterial pressure (baseline: 91.2±19.1 bpm; post 1 min: 89.5±17.7; post 40 min: 89.01±16.88; p=0.99). The variables were presented in terms of means and standard deviations. CONCLUSION: The MCCD maneuver had positive effects by increasing lung volume and pulse oximetry and reducing CO2 expired, without promoting hemodynamic changes in patients undergoing mechanical ventilation.

OBJETIVOS: Avaliar a presença de alterações nos volumes pulmonares, oximetria de pulso, capnografia e alterações hemodinâmicas associadas à intervenção da manobra de compressão e descompressão torácica (MCDT) nos pacientes submetidos à ventilação mecânica (VM). Método: Tratou-se de um estudo prospectivo em que foram incluídos 65 pacientes em VM há mais de 24 horas. O protocolo consistiu na aplicação de manobras de higiene brônquica e, após 30 minutos, os pacientes eram submetidos a dez repetições da MCDT em dez respirações consecutivas no hemitórax direito e, posteriormente, no hemitórax esquerdo, coletando os dados antes e após a aplicação da manobra nos tempos 1, 5, 10, 15, 20, 25, 30, 35 e 40 minutos. RESULTADOS: Constatou-se aumento significante (p<0,001) do volume corrente inspiratório (pré: 458,2±132,1 ml; pós 1 minuto: 557,3±139,1; pós 40 minutos: 574,4±151), volume minuto corrente (pré: 7,0±2,7 L/min; pós 1 minuto: 8,7±3,3; pós 40 minutos: 8,8±3,8) e oximetria de pulso (pré: 97,4±2,2%; pós 1 minuto: 97,9±1,8; pós 40 minutos: 98,2±1,6; p<0,05). Ocorreu redução no CO2 expirado (pré: 35,1±9,0 mmHg; pós 1 minuto: 31,5±8,2; pós 40 minutos: 31,5±8,29; p<0.0001). Não houve alteração significante da frequência cardíaca (pré: 94,5±20,5 mmHg; pós 1 minuto: 94,7±20,5 e pós 40 minutos: 94,9±20,2; p=1) e pressão arterial média (pré: 91,2±19,1 bpm; pós 1 minuto: 89,5±17,7 e pós 40 minutos: 89,0±16,8; p=0,99). As variáveis foram expressas em média e desvio-padrão. CONCLUSÃO: A MCDT possibilita a otimização dos volumes pulmonares, da oximetria de pulso e a redução do CO2 expirado sem promover alterações hemodinâmicas significantes nos pacientes submetidos à ventilação mecânica.

Fisioterapia respiratória na fibrose cística / Respiratory physiotherapy in cystic fibrosis

A fisioterapia torácica convencional (FTC) foi introduzida na década de 1950 como padrão-ouro nos cuidados dos pacientes com fibrose cística (FC), no entanto há poucas evidências para que seu uso seja mantido na rotina diária. Neste trabalho, revisamos a evolução das condutas fisioterapêuticas em pacientes portadores de FC, bem como as novas opções de tratamento, com base nas evidências descritas na literatura nos últimos anos. Na últimas décadas, a fisioterapia respiratória modificou-se consideravelmente introduziu-se novas abordagens, tais como técnicas ativas, os pacientes são mantidos em posições mais confortáveis, que se mostram mais eficazes do que as convencionais. Entre elas, destacamos a pressão expiratória positiva (PEP), PEP oscilatória, ciclo ativo da respiração, aumento do fluxo expiratório, drenagem autógena e drenagem autógena modificada. O paciente deve conhecer e eventualmente participar, juntamente ao profissional, da definição da técnica mais apropriada a seu caso. Para tal, uma boa relação fisioterapeuta-paciente é de fundamental importância.

Conventional chest physiotherapy (CCP) started to be used in the 1950s as the gold standard in the care of patients with cystic fibrosis (CF). However, there is little evidence that its use is maintained in the daily routine. The present review of the literature presents the evolution of the practice of physical therapy in patients with CF, as well as new treatment options based on the evidence described in recent years. In the last decades respiratory physiotherapy has changed considerably. By means of new approaches, such as active techniques, patients are offered more comfortable positions, which are more effective than the conventional ones. Among these techniques, the following are highlighted: positive expiratory pressure (PEP), oscillatory PEP, active cycle of breathing, expiratory flow increase, autogenic drainage, and modified autogenic drainage. Patients must understand the therapy and help the physical therapist to define the most appropriate technique for their cases. A good physical therapistpatient relationship is crucial so that such objective can be achieved.

Comparação dos efeitos de duas técnicas fisioterapêuticas respiratórias em parâmetros cardiorrespiratórios de lactentes com bronquiolite viral aguda / Comparison of the effects that two different respiratory physical therapy techniques have on cardiorespiratory parameters in infants with acute viral bronchiolitis

OBJETIVO: Comparar os efeitos das técnicas de aumento do fluxo expiratório (AFE) e vibração associada à drenagem postural (DP) nos parâmetros cardiorrespiratórios de frequência cardíaca (FC), frequência respiratória (FR) e SpO2 de lactentes com bronquiolite viral aguda (BVA). MÉTODOS: Foram analisados lactentes com diagnóstico clínico e radiológico de BVA. A FC, FR e SpO2 foram registradas em quatro tempos: antes do procedimento e após 10, 30 e 60 min do término do procedimento. Os pacientes foram divididos em três grupos: submetido à AFE; submetido à vibração/DP; e controle. RESULTADOS: Foram incluídos no estudo 81 lactentes, 27 em cada grupo de estudo, com média de idade de 4,52 meses e peso médio de 6,56 kg. Na comparação por ANOVA, as médias da FR, FC e SpO2 nos grupos AFE e vibração/DP não apresentaram diferenças significantes em relação ao grupo controle (p > 0,05). Considerando somente os quatro tempos, houve queda significante dos valores médios de FR nos grupos AFE e vibração/DP em relação ao controle (p < 0,05). CONCLUSÕES: A aplicação de AFE e de vibração associada à DP não apresentou um benefício global na melhora dos parâmetros cardiorrespiratórios em lactentes com BVA. Quando analisados isoladamente no decorrer do tempo, a fisioterapia respiratória parece contribuir na diminuição da FR nesses pacientes.

OBJECTIVE: To compare the expiratory flow increase technique (EFIT) and vibration accompanied by postural drainage (PD) in terms of their effects on the heart rate (HR), respiratory rate (RR) and SpO2 of infants with acute viral bronchiolitis (AVB). METHODS: Infants with clinical and radiological diagnosis of AVB were analyzed. The HR, RR and SpO2 were registered at four time points: prior to the procedure; and at 10, 30 and 60 min after the procedure. The patients were divided into three groups: submitted to the EFIT; submitted to vibration/PD; and control. RESULTS: We included 81 infants, 27 per group, with a mean age of 4.52 years and a mean weight of 6.56 kg. Using ANOVA, we found that the EFIT and vibration/PD groups presented no significant differences in relation to the control group in terms of the mean values for HR, RR or SpO2 (p > 0.05). Considering only the four time points evaluated, the mean RR was significantly lower in the EFIT and vibration/PD groups than in the control group (p < 0.05). CONCLUSIONS: In terms of overall improvement of cardiorespiratory parameters, neither the EFIT nor vibration/PD provided any benefit to infants with BVA. However, over time, respiratory physical therapy seems to contribute to decreasing the RR in these patients.

Empilhamento de ar e compressão torácica aumentam o pico de fluxo da tosse em pacientes com distrofia muscular de Duchenne / Air stacking and chest compression increase peak cough flow in patients with Duchenne muscular dystrophy

OBJETIVO: Avaliar a eficiência da tosse através do uso de duas manobras manuais de auxílio à tosse. MÉTODOS: Foram selecionados 28 pacientes portadores de distrofia muscular de Duchenne em uso de ventilação mecânica não-invasiva noturna e CVF < 60 por cento do previsto. O pico de fluxo da tosse (PFT) foi medido, com o paciente sentado, em quatro momentos: com esforço expiratório máximo (EEM) de forma espontânea (basal), EEM associado à compressão torácica, EEM após empilhamento de ar com bolsa de ventilação e EEM com o uso dessas duas técnicas (técnica combinada). As três últimas medições foram realizadas em ordem aleatória. Os resultados foram comparados usando o teste de correlação de Pearson e ANOVA para medidas repetidas, seguido do teste post hoc de Tukey (p < 0,05). RESULTADOS: A idade média dos pacientes foi de 20 ± 4 anos, e a CVF média foi de 29 ± 12 por cento. A média de PFT basal, com compressão torácica, com empilhamento de ar e com o uso da técnica combinada foi 171 ± 67, 231 ± 81, 225 ± 80, e 292 ±86 L/min, respectivamente. Os resultados com o uso da técnica combinada foram maiores que aqueles com o uso das duas técnicas separadamente [F(3,69) = 67,07; p < 0,001]. CONCLUSÕES: As técnicas de compressão torácica e de empilhamento de ar foram eficientes para aumentar o PFT. No entanto, a combinação dessas manobras teve um efeito aditivo significativo (p < 0,0001).

OBJECTIVE: To evaluate cough efficiency using two manually-assisted cough techniques. METHODS: We selected 28 patients with Duchenne muscular dystrophy. The patients were receiving noninvasive nocturnal ventilatory support and presented FVC values < 60 percent of predicted. Peak cough flow (PCF) was measured, with the patient seated, at four time points: at baseline, during a spontaneous maximal expiratory effort (MEE); during an MEE while receiving chest compression; during an MEE after air stacking with a manual resuscitation bag; and during an MEE with air stacking and compression (combined technique). The last three measurements were conducted in random order. The results were compared using Pearson's correlation test and ANOVA with repeated measures, followed by Tukey's post-hoc test (p < 0.05). RESULTS: The mean age of the patients was 20 ± 4 years, and the mean FVC was 29 ± 12 percent. Mean PCF at baseline, with chest compression, after air stacking and with the use of the combined technique was 171 ± 67, 231 ± 81, 225 ± 80, and 292 ± 86 L/min, respectively. The results obtained with the use of the combined technique were significantly better than were those obtained with the use of either technique alone (F[3.69] = 67.07; p < 0.001). CONCLUSIONS: Both chest compression and air stacking techniques were efficient in increasing PCF. However, the combination of these two techniques had a significant additional effect (p < 0.0001).

Variability of the raised volume rapid thoracic compression technique in infants with recurrent wheezing

Measuring forced expiratory flows from raised lung volume in infants represents a significant advance in the assessment of pulmonary function early in life. However, variability in the main parameters obtained with raised volume rapid thoracic compression (RVRTC), FVC, FEV0.5, FEF50, FEF75, and FEF25-75, has not been completely evaluated. This study was performed to determine the intra-subject variability of spirometric-like parameters in infants with recurrent wheezing obtained with RVRTC. One hundred and two infants with recurrent wheezing (mean age 62 ± 22 weeks) who were asymptomatic at the moment of measuring lung function participated in this study. For the variability analysis, three to five technically acceptable curves at flow-limitation jacket pressure were employed. The mean coefficient of variation (95% CI) of spirometric parameters was as follows: FVC = 2.9% (2.6-3.2); FEV0.5 = 2.2% (1.9-2.5); FEF50 = 3.7% (3.3-4.1); FEF75 = 5.9% (5.2-6.6) and FEF25-75 = 3.3% (2.9-3.7). This study demonstrates the high reproducibility of the spirometric parameters measured with the technique of raised lung volume in infants

La medición del flujo espiratorio forzado con volumen pulmonar aumentado en lactantes supone un avance significativo en la evaluación de la función pulmonar en las primeras etapas de la vida. Sin embargo, no se ha estudiado a fondo la variabilidad de los parámetros principales obtenidos mediante la compresión torácica rápida previa insuflación (CTRIP), tales como FVC, FEV 0.5, FEF 50, FEF 75 y FEF 25-75. El presente estudio tuvo como objetivo determinar la variabilidad en un mismo sujeto de los parámetros espirométricos obtenidos mediante CTRIP en lactantes con respiración sibilante recurrente. Participaron en el estudio 102 lactantes con respiración sibilante recurrente (con una media de edad de 62 ± 22 semanas) que estaban asintomáticos en el momento de medirles la función pulmonar. Para el análisis de la variabilidad se emplearon entre 3 y 5 curvas técnicamente aceptables obtenidas con presiones de compresión en nivel de limitación de flujo. El cociente medio de variación (IC 95%) de los parámetros espirométricos fue el siguiente: FVC = 2,9% (2,6-3,2), FEV 0,5 = 2,2% (1,9-2,5), FEF 50 = 3,7% (3,3-4,1), FEF 75 = 5,9% (5,2-6,6) y FEF 25-75 = 3,3% (2,9-3,7). Este estudio, realizado sobre 102 lactantes con respiración sibilante recurrente, demostró una elevada reproducibilidad de los parámetros espirométricos medidos con la técnica del volumen pulmonar aumentado en lactantes