2001 OPEN FORUM Abstracts
COMPARISONOF CHEST PHYSIOTHERAPY, FLUTTER, AND PEP
CarolynC. Campo, RRT/RCP Evans O. Castor, MBA, RRT Advocate Good Samaritan Hospital Respiratory Care Department 3815 Highland Avenue, Downers Grove,IL 60515
Abstract:: Thisstudy was undertaken to determine the efficacy and costs associated with theflutter device (Flutter) and pep device (PEP) as compared to conventional manualchest physiotherapy (CPT) in hospitalized adult patients undergoing an acuteCOPD exacerbation, pneumonia, or post-surgical bronchial hygiene. CPT is definedas therapy incorporating postural drainage, percussion and vibration as putforth in the American Association of Respiratory Care (AARC) Clinical PracticeGuidelines.
Design: Data was extractedfrom the Clinivision Charting System used by the Respiratory Care Department.The parameters measured were improved breath sounds post treatment, sputum producedpost treatment and the actual treatment time. The staff was unaware of the datacollection or study goals. The devices used as alternatives to CPT were theFlutter® by Scandipharm and the Threshold PEP® by HealthScan. These deviceswere selected by meeting criteria for ease of use and cost to the institution.
Participants: 708 adult patientsover a period of one year with a primary diagnosis or admission for either COPDExacerbation, pneumonia, or surgical/trauma.
Interventions: Patients wereassessed for modality via the secretion management indicators taken from theAmerican Association for Respiratory Care (AARC) Clinical Practice Guidelines.The patients were instructed and supervised by Respiratory Care Practitioners(RCP?s) when performing Flutter or PEP. All patients were monitored for complicationsor adverse reactions to therapy (hemoptysis, hypoxia, increased ICP, pneumothorax,etc.).
Results: CPT, Flutter andPEP all performed at the same level (65 ? 68% positive) for the category ofImproved Breath Sounds Post Treatment. CPT and Flutter were identical (21% positive)for Sputum Production Post Treatment with PEP data being lesser (12% positive).Length of Treatment Time was measured with the average length of a CPT sessionbeing just under 17 minutes. The Flutter averaged about 12-1/2 minutes and thePEP measured almost 13-1/4 minutes.
Experience: Ease of trainingfor the caregiver is significant. Staff was inserviced in less than one hourand able to deliver therapy to patients immediately. Both Flutter and PEP canbe taught to appropriate patients and can be continued past the hospital experience.Staff reported patient satisfaction and positive physiological responses tothese therapies as well as simplicity of teaching to patients and families.
Summary: Flutter appears tobe equally as effective as CPT when used as bronchial hygiene therapy for thepromotion of sputum mobilization and improved breath sounds. PEP did not performquite as well when one looks at the sputum mobilization criteria. However, thenumbers of treatments using PEP were significantly less than the Flutter orCPT and this may be why the sputum produced results are not equal. In additionto the cost savings demonstrated in the time factor, this PEP device is significantlyless costly as compared to the Flutter device. In addition, this PEP devicecan be placed in line with a Medication Nebulizer treatment for appropriatepatients. This may further enhance the medication delivery as well as reducecosts for the facility. Further study of this aspect of use is indicated.