The Science Journal of the American Association for Respiratory Care

2000 OPEN FORUM Abstracts

A COMPARISON OF THE THERAPEUTIC EFFECTIVENESS AND ACCEPTANCE OF PD&P, IPV AND HFCC IN HOSPITALIZED PATIENTS WITH CYSTIC FIBROSIS

Sarah M. Varekojis, MS, RRT and F. Herbert Douce, MS, RRT, Respiratory Therapy Division, The Ohio State University, Columbus, Ohio; Robert Flucke, AS, RRT, David Filbrun, AS, RRT, Jill Tice, MS, RN, Karen McCoy, MD and Robert Castile, MD, MS, Section of Pulmonary Medicine, Children's Hospital, Columbus, Ohio

Background: A significant clinical manifestation of cystic fibrosis (CF) is abnormally abundant and viscous bronchial secretions, which leads to obstruction of bronchi in the lungs and predisposes the individual to chronic pulmonary infections. Bronchopulmonary hygiene is an essential part of the care of patients with cystic fibrosis in order to enhance mucociliary clearance. Currently, several modalities of therapy are available, including postural drainage and percussion (PD&P), high frequency chest wall compression (HFCC) and intrapulmonary percussive ventilation (IPV). The primary purpose of this study was to compare the therapeutic effectiveness of PD&P, HFCC and IPV by measuring wet and dry weights of sputum cleared by hospitalized patients with cystic fibrosis using all 3 modalities. Using a questionnaire, the secondary purpose was to compare subject preferences for each form of bronchopulmonary hygiene, using comfort, convenience, perceived efficacy and ease of use as criteria.

Methods:
This was a randomized cross-over design. Twenty-four patients with CF hospitalized for an acute pulmonary exacerbation completed the study protocol. Each patient received two consecutive days of each form of therapy in random order. All therapies were delivered three times a day for thirty minutes. All sputum produced during the treatment time was expectorated and collected. Sputum was collected for a total of sixty minutes: fifteen minutes before the treatment during aerosol delivery, during the thirty minute treatment time and for fifteen minutes post therapy. Sputum was collected in pre-weighed cups, weighed wet, then dried in a 65°C/150°F oven and weighed again. Participants rated their preferences for each modality using Likert-type scales. The scale was established as 0 being "not at all" and 4 being "extremely." Participants rated each modality on comfort, convenience, perceived efficacy and ease of use as well as overall preference. Mean wet and dry weights were compared among modalities using analysis of variance with repeated measures and Tukey's Honest Significant Difference post-hoc comparison. Patient preferences were also compared using analysis of variance as well as Friedman's test.

Results:
The mean (SD) wet sputum weights (gm) were 5.53(5.69) for PD&P, 6.84(5.41) for IPV, and 4.77(3.29) for HFCC. The mean wet sputum weights differed significantly (p=0.035). Wet sputum weights resulting from IPV were significantly greater than those resulting from HFCC (p < 0.05). The mean (SD) dry sputum weights (gm) were 0.35(0.28) for PD&P, 0.34(0.25) for IPV, and 0.26(0.19) for HFCC. The mean dry sputum weights were not significantly different. The overall preference ranking for each modality was as follows: PD&P 2.00(0.74), IPV 1.92(0.77), HFCC 2.04(0.98). Using the preference ranking and its individual components, none of the 3 bronchopulmonary hygiene techniques was preferred over the others by the subjects.

Conclusions:
We conclude that HFCC and IPV are at least as effective as PD&P for hospitalized patients with CF and that each of the 3 modalities was equally acceptable. The significantly greater wet weights of sputum produced by IPV can most likely be explained by the fact that this modality delivers an aerosol and percussion simultaneously through a mouthpiece. The aerosol and salivation related to the use of the mouthpiece may increase the moisture content of the sputum samples collected using this device. This difference is not clinically significant. The results of this study suggest patients should have the opportunity to experience each therapy and to choose their preferred modality.

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