The Science Journal of the American Association for Respiratory Care

1995 OPEN FORUM Abstracts

Comparison Of Flutter^® To Positive Expiratory Pressure (Pep) Valves: A Laboratory Study

James B. Fink, MS, RRT., Ed Belingon, RRT., Hines VA Hospital and Loyola Univ. Chicago, Stritch School of Medicine, Hines IL, USA

Several devices have been recently approved by the FDA for use in airway clearance with scant data demonstrating physical effects of the devices on airway and lung mechanics. AARC clinical guidelines for Positive Airway Pressure differentiates fixed orifice (FO) resistors (PEP) from threshold (TH) resistors. The aim of this study was to better characterize these two types of resistors as well as the new Flutter^® valve (Scandipharm). We compared the Flutter^® (Scandipharm) to a threshold (Vital Signs) and a fixed orifice (Mercury Medical) resistors, to determine effects on airway pressure patterns, peak expiratory flows (PEFR; L / min), peak expiratory pressure (P_{exp;} cmH_2O), mean airway pressures (MAP;cmH_2O), work of breathing (W_{pt;}Joule / L) and changes in residual volume (RV; ml above baseline) during passive exhalation (V_T 500 ml, PIF 40 L / min) on a test lung with compliance of 0.02 cmH_2O / L. A comparison of the Flutter with TO and FO resistors (at the same relative orifice size) are shown below:

PEFRP_{exp} EPAPW(pt) MAPRV

FLUTTER 27.118.88.41.406 7.5 450

TH 10 cmH_2O 39 15.57.51.255 6.6 450

TH 15 cmH_2O 40 20.6 12.5 1.6949.9 700

FO 4.0 mm 23.7 9.50.30.7380.80

FO 3.0 mm 13.410.20.30.7141.60

FO resulted in lower PEFR, P_{exp}, W(pt) and RV than TH or Flutter (p < .001). The Flutter is similar to the threshold resistor in P_{exp}, EPAP, W(pt), MAP and RV.

We conclude that the characteristics of the FO as a PEP device are sufficiently different from TH and Flutter to be differentiated from EPAP (TH) or Flutter when used in clinical applications and studies.

OF-95-155

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