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Cystic Fibrosis and Pancreatic Disease
Published in Praveen S. Goday, Cassandra L. S. Walia, Pediatric Nutrition for Dietitians, 2022
Elissa M. Downs, Jillian K. Mai, Sarah Jane Schwarzenberg
The complex management of respiratory disease due to thickened secretions and airway changes causes significant burden of disease. Primary interventions for pulmonary manifestations of CF focus on mitigating obstructive airway disease, including bronchodilators, anti-inflammatory therapies, antibiotics for acute and chronic infection, and airway clearance therapies. Vest therapy (high-frequency chest wall oscillation) is frequently used for airway clearance and is used twice a day for about 30 minutes at a time. Ideally, it is done on an empty stomach or at least an hour after meals to prevent emesis, especially in younger children.
Modern Rehabilitation Techniques for COVID-19
Published in Wenguang Xia, Xiaolin Huang, Rehabilitation from COVID-19, 2021
The high-frequency chest wall oscillation (HFCWO) device can effectively reduce the viscosity of the secretion so that the secretion can be discharged from the peripheral airway to the central airway. In addition, it can also prevent atelectasis and control pneumonia.
Physiotherapy and airway clearance
Published in Claudio F. Donner, Nicolino Ambrosino, Roger S. Goldstein, Pulmonary Rehabilitation, 2020
Miguel R. Gonçalves, Amanda J. Piper
HFCWO may act like a physical mucolytic, reducing the viscoelasticity of mucus and enhancing clearance by coughing (20,21,52). High-frequency chest wall oscillation has demonstrated efficacy in assisting mucus clearance in patients with CF (52–55).
Care of children with home mechanical ventilation in the healthcare continuum
Published in Hospital Practice, 2021
Benjamin Kalm, Khanh Lai, Natalie Darro
In patients with poor respiratory strength, it is important to optimize airway clearance. Airway clearance techniques (ACTs) include postural drainage, percussion, chest wall vibration, and coughing. In children on HMV, recommended home equipment includes portable suctioning equipment, a heated humidifier, and a nebulizer/compressor [17]. Of note, many of our patients do not use nebulized medications and therefore do not have a nebulizer/compressor. A mechanical insufflation-exsufflation device (commonly called cough assist) may benefit children with HMV with ineffective cough, such as those with neuromuscular disease with respiratory muscle weakness. In children large enough for proper fitment, high-frequency chest wall oscillation is indicated for impaired clearance of secretions with impaired mobility. There is a lack of randomized controlled trials regarding choice of different ACT modalities in the pediatric HMV population.
Rehabilitation, a necessity in hospitalized and discharged people infected with COVID-19: a narrative review
Published in Physical Therapy Reviews, 2021
Najmeh Sedighimehr, Javad Fathi, Nahal Hadi, Zahra Sadat Rezaeian
Respiratory rehabilitation can be started if the individual reached minimal clinical stability and met the ResRehab criteria (controlled fever, mollified dyspnea, respiratory rate <30 bpm, SpO2 >90% is reached) [70]. Also all respiratory safety considerations, including intubation status, ventilator parameters and the need for adjunctive therapies should be satisfied [71]. Rehabilitation intervention at this stage can include proper positioning, scheduled change in position, respiratory muscle training up to the individual’ tolerance, high-frequency chest wall oscillation (HFCWO), and oscillatory positive expiratory pressure [59,72]. Of course, close monitoring should be occurred during ResRehab. The applications need to be discontinued if:The respiratory rate >30 bpm,SpO2 <90% (despite oxygen support therapy),FiO2 >50% on a non-invasive ventilator,PEEP/CPAP >10 cmH2O,Bradycardia, tachycardia, and variable arrhythmias [61].
Effect of airway clearance techniques in patients experiencing an acute exacerbation of bronchiectasis: a systematic review
Published in Physiotherapy Theory and Practice, 2020
Jennifer Phillips, Annemarie Lee, Rodney Pope, Wayne Hing
Previous reviews and research have focused on the use of ACTs during the stable clinical state of bronchiectasis, showing that various techniques such as PEP therapy, oscillating PEP therapy, PD, expiration with glottis open in lateral position (ETGOL), and high frequency chest wall oscillation are safe and effective at increasing sputum production compared to no intervention (Lee, Burge, and Holland, 2015; Lee, Williamson, Lorensini, and Spencer, 2015; Muñoz et al, 2018). However, there is very limited evidence regarding the effectiveness of ACTs during an acute exacerbation of bronchiectasis that is not associated with cystic fibrosis. In the one previous review which included individuals experiencing an acute exacerbation as well as those in a stable state, the results did not separately analyze the findings based on clinical state and so the authors could only conclude that ACTs were safe for individuals during the stable state of their disease (Snijders et al, 2015). There have been no systematic reviews investigating ACTs exclusively in individuals experiencing an acute exacerbation. The primary aim of this systematic review was, therefore, to establish if ACTs are safe for individuals experiencing an acute exacerbation of bronchiectasis not associated with cystic fibrosis. The secondary aim was to establish the effectiveness of ACTs in improving outcomes including sputum clearance, lung function, arterial blood gases (ABGs), quality of life, and breathlessness for these individuals.