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BACKGROUND: Airway clearance techniques are regularly proposed as a part of the treatment in chronic obstructive airway diseases. Intrapulmonary percussive ventilation (IPV) is used as an airway clearance technique in patients affected by excessive lung secretions. The aim of this systematic review is to summarize the physiological and clinical effects related to the use of IPV as an airway clearance technique in chronic obstructive airway diseases. METHODS: This systematic review followed the PRISMA guidelines. Randomized, controlled, comparative, and cohort studies investigating IPV as an airway clearance technique were identified and reviewed from 3 databases. Two reviewers independently assessed study quality and reviewed the selected studies. RESULTS: 278 subjects from 12 studies were included in the final analysis, with 3 diseases studied. Only one of the included studies had a sample size > 50 subjects. The main findings showed that IPV improves gas exchange during exacerbation and could reduce the hospital length of stay for patients with COPD. In subjects with cystic fibrosis, neither lung function nor other parameters were improved. CONCLUSIONS: The systematic use of IPV as an airway clearance technique in chronic obstructive airway diseases is not supported by sufficiently strong evidence to recommend routine use in this patient population.

The use of nebulization is becoming increasingly frequent in treatment of acute or chronic lung diseases for delivery of topically active drugs and is also an attractive way to deliver systemic drugs. A nebulizer can be defined by the aerodynamic properties of the emitted particles which are directly related to the lung deposition and the clinical response to a nebulized drug. New guidelines elaborated by an European norm (ENFR13544-1) aim to participate to a better control on quality and efficiency of existing devices and inspired the elaboration of the studies of this thesis. The aim of these works was to evaluate the nebulization function of a new kind of modality, the intrapulmonary percussive ventilation which contrarily to classical jet nebulizers nebulizes drugs under superimposed percussion conditions. In vitro measurements were realized by cascade impaction and laser diffraction. Lung deposition was investigated by imagery techniques and pharmacokinetic study. Aerodynamic properties were different between the in vitro methods. When measured by cascade impaction, MMAD and FPF were smaller for IPV comparatively to SST. By laser diffraction, FPF remained lower but MMAD was higher with IPV than with SST. The effect of percussions was greater on MMAD than on FPF. An irregular intrapulmonary deposition and a higher whole body deposition due to a higher extrapulmonary deposition with the IPV were measured by scintigraphy. The pharmacokinetic study highlighted that the drug output and the lung dose were lower when amikacin was delivered by IPV comparatively to SST. All results of these different studies seem unfavourable to the use of intrapulmonary percussive ventilation as modality of administration for nebulized drugs without further investigations. Results presented in this thesis concerning exclusively healthy subjects, we hope that they encouraged to perform complementary analysis and observations in different conditions such as patients with lung disease., (READ 3)--UCL, 2006

The intrapulmonary percussive ventilation (IPV), frequently coupled with a nebulizer, is increasingly used as a physiotherapy technique; however, its physiologic and clinical values have been poorly studied. The aim of this study was to compare lung deposition of amikacin by the nebulizer of the IPV device (Percussionaire; Percussionaire Corporation; Sandpoint, ID) and that of standard jet nebulization (SST; SideStream; Medic-Aid; West Sussex, UK). Amikacin was nebulized with both devices in a group of five healthy subjects during spontaneous breathing. The deposition of amikacin was measured by urinary monitoring. Drug output of both devices was measured. Respiratory frequency (RF) was significantly lower when comparing the IPV device with SST (8.2 +/- 1.6 breaths/min vs. 12.6 +/- 2.5 breaths/min, p < 0.05). The total daily amount of amikacin excreted in the urine was significantly lower with IPV than with SST (0.8% initial dose vs. 5.6% initial dose, p < 0.001). Elimination halflife was identical with both devices. Drug output was lower with IPV than with SST. The amount of amikacin delivered to the lung is sixfold lower with IPV than with SST, although a lower respiratory frequency was adopted by the subjects with the IPV. Therefore, the IPV seems unfavorable for the nebulization of antibiotics.

BACKGROUND: So-called intrapulmonary percussive ventilation (IPV), frequently coupled with a nebulizer, is increasingly used as a physiotherapy technique; however, its physiologic and clinical values have not been rigorously assessed. STUDY OBJECTIVE: To compare in vitro and in vivo characteristics of the nebulizer of the IPV device (Percussionaire; Percussionaire Corporation; Sandpoint, ID) with those of standard jet nebulization (SST) [SideStream; Medic-Aid; West Sussex, UK]. DESIGN: Aerodynamic particle size was studied by an cascade impactor. The deposition of (99m)Tc-diethylenetriaminepenta-acetic acid was measured in 10 healthy subjects by tomoscintigraphy during spontaneous breathing with both nebulizers. Measurements and results: The mass median aerodynamic diameter (0.2 micro m vs 1.89 micro m for IPV and SST, respectively) and the fine-particle fraction (16.2% vs 67.5%, respectively) were significantly smaller with IPV. In vivo, respiratory frequency (RF) was lower with the IPV device (10.1 +/- 3.4 breaths/min vs 14.6 +/- 3.4 breaths/min, p = 0.002). Whole-body deposition was significantly higher with IPV (15.63% vs 9.31%), but it was due to a higher extrapulmonary deposition. Although intrapulmonary deposition (IPD) was not different with both devices (4.20% for SST vs 2.49% for IPV), it was much more variable with IPV, compared to SST. The penetration index into the lung was higher with IPV than SST when normalized for RF (0.045 +/- 0.018 breaths/min vs 0.026 +/- 0.013 breaths/min, p = 0.007). CONCLUSION: The two techniques showed comparable lung deposition despite a large difference in particle size. However, IPV IPD was too variable and thus too unpredictable to recommend its use for drug delivery to the lung.