The Science Journal of the American Association for Respiratory Care

2003 OPEN FORUM Abstracts

SAFETY AND TOLERANCE OF HIGH-FREQUENCY CHEST WALL OSCILLATION (HFCWO) IN HOSPITALIZED CRITCAL CARE PATIENTS

Scott Brierley, RRT, Christine Adams, BA, RRT, Janet Suelter, CRT, Troy Gooch MBA, RRT, Brian Becker, MEd, RRT.

Arizona Heart Hospital, Phoenix, AZ, Salina Regional Health Center, Salina KS, Advanced Respiratory Inc., Saint Paul, MN

Introduction: Pulmonary complications are common in hospitalized patients. Surgical procedures and other therapeutic interventions can increase the risk of pulmonary complications while interfering with the ability to tolerate the treatment for those complications. High-frequency chest wall oscillation (HFCWO) is used for airway clearance in a wide variety of patients. However, limited data is available regarding its use in critical care patients.

Rationale: We hypothesized that HFCWO would provide a safe, well-tolerated alternative to traditional chest physiotherapy (CPT). The purpose of this project was to assess safety and tolerance in acutely ill hospitalized patients in the presence of multiple therapeutic interventions.

Methods:
Enrollment criteria included a physician order for HFCWO therapy and the presence of one or more concurrent therapies or equipment. HFCWO was delivered using The Vestä Airway Clearance System (Advanced Respiratory Inc., Saint Paul, MN). Typical therapy regimen included 15 minutes of HFCWO therapy 2 to 3 times per day. Concurrent therapy/equipment and therapist subjective assessment of tolerance (using a Likert scale) were documented on a daily basis.

Patient Population: Seventy-three subjects ages 25 to 85, were enrolled. Seventy-one (97%) were post-surgical patients (cardiac surgery n=53, abdominal surgery n=14, thoracic surgery n=3, other surgery n=2). Thirty-three (46%) of the post-surgical patients were initiated on therapy within 24 hours of surgery. Twenty-eight (39%) were initiated between 25 and 72 hours, and ten subjects (14%) more that 72 hours post surgery. Two subjects were non-surgical patients.
Concurrent Equipment or Therapy

  Number of Subjects Days of HFCWO Therapy
Sternal Incision/Sternal Wires 48 112
Chest Tubes 24 35
External Pacer Wires 30 43
Swan-Ganz Catheter 27 51
Penrose Drains 23 35
Central Venous Pressure Line 21 42
Implanted Pacemaker 11 11
CPAP or BiLevel 5 5
Mechanical Ventilation 1 2
Internal Cardiac Defibrillator 1 1


RESULTS:
A total of 179 HFCWO therapy days were evaluated. No significant adverse events were reported. However, 12 patients (16.4%) were discontinued within the first 72 hours because of inability to tolerate therapy. One patient experienced pain associated with a hematoma, one experienced tachycardia during therapy. Other reasons for discontinuation included incisional pain, nausea and shortness of breath. Subjective tolerance ratings (1 = poorly tolerated, 5 = well tolerated) for all therapy days were: Mean + SD = 4.3 + .94, Median = 5.0

CONCLUSION:
HFCWO via The Vest is a safe and well-tolerated airway clearance alternative for many post surgical and other critical care patients. Additional studies are underway to determine utility and effectiveness in specific hospitalized patient populations.

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