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BACKGROUND: Intrapulmonary percussive ventilation (IPV) is frequently used for airway clearance, together with delivery of aerosolized medications. Drug delivery via IPV alone increases with decreasing percussion frequency and correlates with tidal volume (VT), whereas drug delivery via IPV during invasive ventilation is not well characterized. We hypothesized that drug delivery via IPV-invasive ventilation would differ from IPV alone due to control of ventilation by invasive ventilation. METHODS: An adult ventilator circuit was used for IPV-invasive ventilation. A normal or a diseased lung model was configured to airway resistance of 5 cm H2O/L/s and lung compliance of 100 mL/cm H2O or to airway resistance of 20 cm H2O/L/s and lung compliance of 50 mL/cm H2O, respectively. The ventilator settings were the following: pressure control continuous mandatory ventilation mode, 10 breaths/min; PEEP, 5 cm H2O; ..., 0.21; inspiratory time, 1 s; no bias flow; and inspiratory pressure, 10 or 15 cm H2O for the normal or the diseased lung model, respectively, to reach VT 500 mL with IPV off. Albuterol nebulized from an IPV device was captured in a filter placed before the lung model and quantitated by spectrophotometry. RESULTS: The maximum efficiency of albuterol delivery via IPV-invasive ventilation was not different from that via IPV alone (mean ± SD of loading dose, 3.7 ± 0.2% vs 4.2 ± 0.3%, respectively; P = .12). The mean ± SD albuterol delivery efficiency with IPV-invasive ventilation was lower for the diseased lung model versus the normal model (1.6 ± 0.3% vs 3.2 ± 0.5%; P < .001), which increased with decreasing percussion frequency. In contrast, the mean ± SD was lower for the normal lung model versus the diseased model (401 ± 14 mL vs 470 ± 11 mL; P < .001). CONCLUSIONS: Albuterol delivery via IPV-invasive ventilation was modulated by percussion frequency but was not increased with increasing VT. The delivery efficiency was not sufficiently high for clinical use, in part due to nebulizer retention and extrapulmonary deposition. [ABSTRACT FROM AUTHOR]

Impaired respiratory function secondary to acute or chronic respiratory disease poses a significant clinical and healthcare burden. Intrapulmonary percussive ventilation (IPV) is used in various clinical settings to treat excessive airway secretions, pulmonary atelectasis, and impaired gas exchange. Despite IPV’s wide use, there is a lack of clinical guidance on IPV application which may lead to inconsistency in clinical practice. This scoping review aimed to summarise the clinical application methods and dosage of IPV used by clinicians and researchers to provide guidance. A two-staged systematic search was conducted to retrieve studies that used IPV in inpatient and outpatient settings. MEDLINE, EMBASE, CINAHL, Scopus, and Google scholar were searched from January 1979 till 2022. Studies with patients aged ≥16 years and published in any language were included. Two reviewers independently screened the title and abstract, reviewed full text articles, and extracted data. Search yielded 514 studies. After removing duplicates and irrelevant studies, 25 studies with 905 participants met the inclusion criteria. This is the first scoping review to summarise IPV application methods and dosages from the available studies in intensive care unit (ICU), acute inpatient (non-ICU), and outpatient settings. Some variations in clinical applications and prescribed dosages of IPV were noted. Despite variations, common trends in clinical application and prescription of IPV dosages were observed and summarised to assist clinicians with IPV intervention. Although an evidence-based clinical guideline could not be provided, this review provides detailed information on IPV application and dosages in order to provide clinical guidance and lays a foundation towards developing a clinical practice guideline in the future.

BACKGROUND: Patients receiving mechanical ventilation often require airway clearance and inhaled therapies. Intrapulmonary percussive ventilation (IPV) combines a high-frequency percussive ventilator with a jet nebulizer. Data on aerosol delivery efficiency of the device are scarce. We evaluated albuterol delivery efficiency while using an IPV in-line adapter under different conditions. METHODS: A pediatric lung model of invasive mechanical ventilation was used. The following independent variables were evaluated: lung condition (normal vs ARDS), ventilator mode (adaptive pressure ventilation vs pressure control), percent opening of adapter (0% vs 25% vs 50%), IPV driving pressure (25 psi vs 40 psi), IPV percussion setting (easy vs hard), and endotracheal tube (ETT) size (3.5 mm vs 5.5 mm). Albuterol delivery efficiency (mass captured in the filter expressed as percentage of loading dose) was selected as the dependent variable. Albuterol was captured on a filter at the tip of the ETT and quantified via spectrophotometry (276 nm). RESULTS: Albuterol delivery efficiency ranged from 0-2.89%. Median (interquartile range) and 95% CI around the median were 0.54% (0.37-1.00) and 0.50-0.63%, respectively. The coefficient of determination (R²) for the model including all variables was 0.363. The 2 main contributors were percent of adapter opening (R² 0.30) and IPV setting (R² 0.039). CONCLUSIONS: Albuterol delivery during invasive mechanical ventilation via in-line IPV in a pediatric lung model was inefficient. Alternative methods of delivering bronchodilators and other inhaled medications should be considered when IPV is used. [ABSTRACT FROM AUTHOR]

Lung disease in cystic fibrosis (CF) is characterized by reduced mucociliary clearance, airway plugging, recurrent infections, and chronic pulmonary inflammation. Patients who are affected undergo daily respiratory physiotherapy to improve airway clearance. Intrapulmonary percussive ventilation (IPV) is a technique used in clinical practice, but it is not commonly used in CF patients. Evidence for various respiratory pathologies, particularly in children, is still lacking. We present the case of an 11-year-old boy with cystic fibrosis who did not respond to traditional respiratory physiotherapy techniques. We proposed and tested the use of IPV during hospitalization. In this case, the use of IPV in physiotherapy treatment reduced the need for intravenous antibiotics, hospitalization, and improved radiologic features. IPV can be used successfully in CF patients who are resistant to traditional physiotherapy techniques. [ABSTRACT FROM AUTHOR]

Lung disease in cystic fibrosis (CF) is characterized by reduced mucociliary clearance, airway plugging, recurrent infections and chronic pulmonary inflammation. Patients who are affected undergo daily respiratory physiotherapy to improve airway clearance. Intrapulmonary percussive ventilation (IPV) is a technique used in clinical practice, but it is not commonly used in CF patients. Evidence in various respiratory pathologies, particularly in children, is still lacking. We present the case of an eleven-year-old boy with cystic fibrosis who did not respond to traditional respiratory physiotherapy techniques. We proposed and tested the use of IPV during hospitalization. In this case, the use of IPV in physiotherapy treatment reduced the need for intravenous antibiotics, hospitalization, and improved radiologic features. IPV can be used successfully in CF patients who are resistant to traditional physiotherapy techniques.

Abstract Background Intrapulmonary percussive ventilation (IPV) facilitates the mobilization and clearance of bronchial secretions. Cricothyroidotomy using a Mini-Trach II device is a minimally invasive method used for secretion clearance. To our knowledge, there are no previous reports regarding IPV combined with Mini-Trach II. Case presentation An 82-year-old man underwent controlled mechanical ventilation and IPV via an endotracheal tube to treat atelectasis following emergency surgical repair of a traumatic diaphragm laceration. He underwent cricothyroidotomy using Mini-Trach II for ensuring airway management after extubation. On resumption, IPV through a mouthpiece or face mask was unsuccessful owing to air leakage from his mouth. However, IPV via the already inserted Mini-Trach II could deliver the percussion flow and led to a marked improvement in his condition. Conclusion This experience indicates that Mini-Trach II is beneficial as a minimally invasive interface for IPV that can deliver percussion flow efficiently.

Background: Intrapulmonary percussive ventilation (IPV) is frequently used for airway clearance, together with delivery of aerosolized medications. Drug delivery via IPV alone increases with decreasing percussion frequency and correlates with tidal volume ([Formula: see text]), whereas drug delivery via IPV during invasive ventilation is not well characterized. We hypothesized that drug delivery via IPV-invasive ventilation would differ from IPV alone due to control of ventilation by invasive ventilation., Methods: An adult ventilator circuit was used for IPV-invasive ventilation. A normal or a diseased lung model was configured to airway resistance of 5 cm H 2 O/L/s and lung compliance of 100 mL/cm H 2 O or to airway resistance of 20 cm H 2 O/L/s and lung compliance of 50 mL/cm H 2 O, respectively. The ventilator settings were the following: pressure control continuous mandatory ventilation mode, 10 breaths/min; PEEP, 5 cm H 2 O; [Formula: see text], 0.21; inspiratory time, 1 s; no bias flow; and inspiratory pressure, 10 or 15 cm H 2 O for the normal or the diseased lung model, respectively, to reach [Formula: see text] 500 mL with IPV off. Albuterol nebulized from an IPV device was captured in a filter placed before the lung model and quantitated by spectrophotometry., Results: The maximum efficiency of albuterol delivery via IPV-invasive ventilation was not different from that via IPV alone (mean ± SD of loading dose, 3.7 ± 0.2% vs 4.2 ± 0.3%, respectively; P = .12). The mean ± SD albuterol delivery efficiency with IPV-invasive ventilation was lower for the diseased lung model versus the normal model (1.6 ± 0.3% vs 3.2 ± 0.5%; P < .001), which increased with decreasing percussion frequency. In contrast, the mean ± SD [Formula: see text] was lower for the normal lung model versus the diseased model (401 ± 14 mL vs 470 ± 11 mL; P < .001)., Conclusions: Albuterol delivery via IPV-invasive ventilation was modulated by percussion frequency but was not increased with increasing [Formula: see text]. The delivery efficiency was not sufficiently high for clinical use, in part due to nebulizer retention and extrapulmonary deposition., Competing Interests: The authors have disclosed no conflicts of interest., (Copyright © 2024 by Daedalus Enterprises.)

Background: Intrapulmonary percussive ventilation (IPV) facilitates the mobilization and clearance of bronchial secretions. Cricothyroidotomy using a Mini-Trach II device is a minimally invasive method used for secretion clearance. To our knowledge, there are no previous reports regarding IPV combined with Mini-Trach II. Case presentation: An 82-year-old man underwent controlled mechanical ventilation and IPV via an endotracheal tube to treat atelectasis following emergency surgical repair of a traumatic diaphragm laceration. He underwent cricothyroidotomy using Mini-Trach II for ensuring airway management after extubation. On resumption, IPV through a mouthpiece or face mask was unsuccessful owing to air leakage from his mouth. However, IPV via the already inserted Mini-Trach II could deliver the percussion flow and led to a marked improvement in his condition. Conclusion: This experience indicates that Mini-Trach II is beneficial as a minimally invasive interface for IPV that can deliver percussion flow efficiently. [ABSTRACT FROM AUTHOR]

Impaired respiratory function secondary to acute or chronic respiratory disease poses a significant clinical and healthcare burden. Intrapulmonary percussive ventilation (IPV) is used in various clinical settings to treat excessive airway secretions, pulmonary atelectasis, and impaired gas exchange. Despite IPV's wide use, there is a lack of clinical guidance on IPV application which may lead to inconsistency in clinical practice. This scoping review aimed to summarise the clinical application methods and dosage of IPV used by clinicians and researchers to provide guidance. A two-staged systematic search was conducted to retrieve studies that used IPV in inpatient and outpatient settings. MEDLINE, EMBASE, CINAHL, Scopus, and Google scholar were searched from January 1979 till 2022. Studies with patients aged ≥16 years and published in any language were included. Two reviewers independently screened the title and abstract, reviewed full text articles, and extracted data. Search yielded 514 studies. After removing duplicates and irrelevant studies, 25 studies with 905 participants met the inclusion criteria. This is the first scoping review to summarise IPV application methods and dosages from the available studies in intensive care unit (ICU), acute inpatient (non-ICU), and outpatient settings. Some variations in clinical applications and prescribed dosages of IPV were noted. Despite variations, common trends in clinical application and prescription of IPV dosages were observed and summarised to assist clinicians with IPV intervention. Although an evidence-based clinical guideline could not be provided, this review provides detailed information on IPV application and dosages in order to provide clinical guidance and lays a foundation towards developing a clinical practice guideline in the future., Competing Interests: Authors have no conflicts of interest to declare., (© 2024, Hong Kong Physiotherapy Association.)

Abstract Pulmonary alveolar proteinosis (PAP) is a rare disease characterized by abnormal accumulation of surfactant in the alveoli. Whole lung lavage (WLL) is the standard treatment for severe autoimmune PAP (aPAP); however, it is highly invasive. Intrapulmonary percussive ventilation (IPV) is a non‐invasive technique that delivers small bursts of high‐flow respiratory gas into the lung and mobilizes secretions. As IPV is beneficial for chronic respiratory diseases such as cystic fibrosis and bronchiectasis to reduce sputum, it was hypothesized that IPV will ameliorate aPAP by mobilizing and removing accumulated surfactant and foamy macrophages. Here, we report the case of a 52‐year‐old female with severe aPAP and progressive respiratory failure. She received intermittent IPV therapy for six months and thereby showed improvement in assessments of chest computed tomography (CT), lung function, and oxygenation. We suggest that IPV should be used as an alternative therapy for patients with aPAP and respiratory failure.

Antonello Nicolini,1 Bruna Grecchi,2 Maura Ferrari-Bravo,3 Cornelius Barlascini4 1Respiratory Diseases Unit, Hospital of Sestri Levante, Sestri Levante, Italy; 2Rehabilitation Unit, ASL4 Chiavarese, Chiavari, Italy; 3Statistics Unit, ASL4 Chiavarese, Chiavari, Italy; 4Health Medicine Unit, Hospital of Sestri Levante, Sestri Levante, Italy Purpose: Chest physiotherapy is an important tool in the treatment of COPD. Intrapulmonary percussive ventilation (IPV) and high-frequency chest wall oscillation (HFCWO) are techniques designed to create a global percussion of the lung which removes secretions and probably clears the peripheral bronchial tree. We tested the hypothesis that adding IPV or HFCWO to the best pharmacological therapy (PT) may provide additional clinical benefit over chest physiotherapy in patients with severe COPD. Methods: Sixty patients were randomized into three groups (20 patients in each group): IPV group (treated with PT and IPV), PT group with (treated with PT and HFCWO), and control group (treated with PT alone). Primary outcome measures included results on the dyspnea scale (modified Medical Research Council) and Breathlessness, Cough, and Sputum scale (BCSS), as well as an evaluation of daily life activity (COPD Assessment Test [CAT]). Secondary outcome measures were pulmonary function testing, arterial blood gas analysis, and hematological examinations. Moreover, sputum cell counts were performed at the beginning and at the end of the study. Results: Patients in both the IPV group and the HFCWO group showed a significant improvement in the tests of dyspnea and daily life activity evaluations (modified Medical Research Council scale, BCSS, and CAT) compared to the control group, as well as in pulmonary function tests (forced vital capacity, forced expiratory volume in 1 second, forced expiratory volume in 1 second/forced vital capacity%, total lung capacity, residual volume, diffusing lung capacity monoxide, maximal inspiratory pressure, maximal expiratory pressure) and arterial blood gas values. However, in the group comparison analysis for the same variables between IPV group and HFCWO group, we observed a significant improvement in the IPV group maximal inspiratory pressure, maximal expiratory pressure, BCSS, and CAT. Similar results were observed in changes of sputum cytology with reduction of inflammatory cells (neutrophils and macrophages). Conclusion: The two techniques improved daily life activities and lung function in patients with severe COPD. IPV demonstrated a significantly greater effectiveness in improving some pulmonary function tests linked to the small bronchial airways obstruction and respiratory muscle strength and scores on health status assessment scales (BCSS and CAT) as well as a reduction of sputum inflammatory cells compared with HFCWO. Keywords: severe COPD, intrapulmonary percussive ventilation, high-frequency chest wall oscillation, daily life activity

Pulmonary alveolar proteinosis (PAP) is a rare disease characterized by abnormal accumulation of surfactant in the alveoli. Whole lung lavage (WLL) is the standard treatment for severe autoimmune PAP (aPAP); however, it is highly invasive. Intrapulmonary percussive ventilation (IPV) is a non‐invasive technique that delivers small bursts of high‐flow respiratory gas into the lung and mobilizes secretions. As IPV is beneficial for chronic respiratory diseases such as cystic fibrosis and bronchiectasis to reduce sputum, it was hypothesized that IPV will ameliorate aPAP by mobilizing and removing accumulated surfactant and foamy macrophages. Here, we report the case of a 52‐year‐old female with severe aPAP and progressive respiratory failure. She received intermittent IPV therapy for six months and thereby showed improvement in assessments of chest computed tomography (CT), lung function, and oxygenation. We suggest that IPV should be used as an alternative therapy for patients with aPAP and respiratory failure. [ABSTRACT FROM AUTHOR]

We developed a training protocol based on Intrapulmonary Percussive Ventilation in order to prolong breath-hold while nearly suppressing the thorax motion. This protocol allowed ten subjects to achieve a 20-minutes-breath-hold, while reducing the residual surface motion to 1 mm around its mean position for more than 95% of the breath-hold duration. [ABSTRACT FROM AUTHOR]

BACKGROUND: Intrapulmonary percussive ventilation (IPV) is used for airway clearance and delivery of aerosol medications, including bronchodilators. Despite the common use of IPV for drug delivery, few data are available regarding optimization of inhalation therapy with IPV. In this study, we investigated the influence of IPV setting parameters and lung mechanics on drug delivery via IPV alone. METHODS: An IPV device was connected to a lung model via a trachea model and a flow analyzer. Albuterol nebulized from the IPV device was collected onto a filter attached between the trachea and lung models, and was quantitated by spectrophotometry (230 nm). RESULTS: Albuterol delivery to the lung model was increased up to 2.1-fold, with decreasing percussion frequency. Decreasing percussion frequency concomitantly increased the tidal volume, and albuterol delivery was correlated with tidal volume (r = 0.91, P < .001). Airway resistance had a negative impact on albuterol delivery, whereas lung compliance had no significant effect. Increasing operational pressure increased albuterol delivery while increasing peak inspiratory pressure. CONCLUSIONS: Albuterol delivery and tidal volume with IPV can be improved by maintaining low levels of percussion frequency and increasing operational pressure. When increasing operational pressure, the peak inspiratory pressure and airway resistance levels need to be carefully monitored for safe inhalation therapy with IPV. [ABSTRACT FROM AUTHOR]

The article presents a case study related to 6-year-old girl with chronic cough and atelectasis was transferred to our clinic. Topics include the primary ciliary dyskinesia (PCD) is an autosomal recessive disease characterized by chronic upper and lower respiratory tract infection, the important to improve airway clearance and reduce lung injury with early diagnosis, and the lack of evidence-based treatments and preventions available for PCD.

High levels of shear stress can prevent and disrupt Pseudomonas aeruginosa biofilm formation in vitro. Intrapulmonary percussive ventilation (IPV) could be used to introduce shear stress into the lungs of cystic fibrosis (CF) patients to disrupt biofilms in vivo. We performed a first-of-its-kind pilot clinical study to evaluate short-term IPV therapy at medium (200 bursts per minute, bpm) and high frequency (400 bpm) as compared to autogenic drainage (AD) on lung function and the behavior of P. aeruginosa in the CF lung in four patients who are chronically colonized by P. aeruginosa. A significant difference between the three treatment groups was observed for both the forced expiratory volume in 1 s (FEV1) and the forced vital capacity (FVC) (p < 0.05). More specifically, IPV at high frequency significantly increased FEV1 and FVC compared to AD (p < 0.05) and IPV at medium frequency (p < 0.001). IPV at high frequency enhanced the expression levels of P. aeruginosa planktonic marker genes, which was less pronounced with IPV at medium frequency or AD. In conclusion, IPV at high frequency could potentially alter the behavior of P. aeruginosa in the CF lung and improve lung function. Trial registration: The trail was retrospectively registered at the ISRCTN registry on 6 June 2013, under trial registration number ISRCTN75391385. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Intrapulmonary percussive ventilation (IPV) has been postulated to enhance mucociliary clearance by improving tracheobronchial sputum rheological properties. The IPV effects on linear (viscoelasticity) and non-linear (flowing) rheological properties of 40 sputum samples collected from 19 patients with muco-obstructive lung diseases were investigated ex-vivo. Each sputum sample was split into 4 aliquots. These aliquots were independently placed in a circuit connected on one side to an IPV device and on the other side to a lung model that simulated spontaneous adult breaths. IPV was superimposed on simulated breathing. Three aliquots were exposed to a different IPV setting, modifying either percussion frequency or amplitude (4 Hz-200 L/min, 10 Hz-200 L/min, 10 Hz-140 L/min). One aliquot was only exposed to breathing (IPV was switched off, control condition). Each aliquot underwent 5 min of the pre-fixed mechanical stimulation before being recollected to proceed to rheological analysis. Neither percussion frequencies nor amplitudes had a significant impact on any sputum rheological properties studied. These results need to be confirmed in vivo. • The intrapulmonary percussive ventilation (IPV) effect on mucus rheology is unclear. • Sputum samples were collected from patients with muco-obstructive lung diseases. • These samples were exposed to several IPV settings. • Regardless the settings, the intended effects of IPV were not shown. • The clinical benefits of IPV may be explained by other factors than mucus rheology. [ABSTRACT FROM AUTHOR]

Children with progressive neuromuscular weakness undergo a stereotypical progression of respiratory involvement, beginning with impaired airway clearance and progressing to nocturnal and then diurnal ventilatory failure. This review examines issues related to airway clearance and mucus mobilization, sleep problems, and use of assisted ventilation in children with neuromuscular diseases. Interventions for each of these problems have been created or adapted for the pediatric population. The use of airway clearance therapies and assisted ventilation have improved survival of children with neuromuscular weakness. Questions regarding the best time to introduce some therapies, the therapeutic utility of certain interventions, and the cost-effectiveness of various treatments demand further investigation. Studies that assess the potential to improve quality of life and reduce hospitalizations and frequency of lower-respiratory tract infections will help clinicians to decide which techniques are best suited for use in children. As children with neuromuscular disease survive longer, coordinated programs for transitioning these patients to adult care must be developed to enhance their quality of life. [ABSTRACT FROM AUTHOR]

To determine the strength of the evidence evaluating the effectiveness of intrapulmonary percussive ventilation (IPV) as a safe alternative or adjunctive therapy to traditional chest physiotherapy (CPT) among potential organ donors.~Objective~Objective~Literature search conducted from February 2015 to November 2015 using PubMed, Cumulative Index of Nursing and Allied Health Literature, Scopus, and bibliographies of pertinent articles. Search Terms: Intrapulmonary percussive ventilation, chest physiotherapy, chest wall oscillation, organ donors, and ventilation.~Data Sources~Methods~Articles in English from 1994 to present directly compared IPV to CPT or conventional (no) therapy.~Study Selection~Methods~Association of Critical-Care Nurses Levels of Evidence was used to determine the strength of evidence. Level B and level C articles were reviewed.~Data Extraction~Methods~No studies were found using IPV in the donor population. Results from studies using IPV in other populations indicated IPV had no adverse effects, improved sputum clearance and oxygenation, and reduced atelectasis and pneumonia in patients with artificial airways.~Data Synthesis~Results~Intrapulmonary percussive ventilation may be a safe and effective alternative or adjunctive to CPT therapy and improve the number of lungs available for transplantation. Clinical research is essential to determine the effectiveness of this therapy for lung recruitment in the donor population.~Conclusion~Conclusions [ABSTRACT FROM AUTHOR]

Background: Patients receiving mechanical ventilation often require airway clearance and inhaled therapies. Intrapulmonary percussive ventilation (IPV) combines a high-frequency percussive ventilator with a jet nebulizer. Data on aerosol delivery efficiency of the device are scarce. We evaluated albuterol delivery efficiency while using an IPV in-line adapter under different conditions., Methods: A pediatric lung model of invasive mechanical ventilation was used. The following independent variables were evaluated: lung condition (normal vs ARDS), ventilator mode (adaptive pressure ventilation vs pressure control), percent opening of adapter (0% vs 25% vs 50%), IPV driving pressure (25 psi vs 40 psi), IPV percussion setting (easy vs hard), and endotracheal tube (ETT) size (3.5 mm vs 5.5 mm). Albuterol delivery efficiency (mass captured in the filter expressed as percentage of loading dose) was selected as the dependent variable. Albuterol was captured on a filter at the tip of the ETT and quantified via spectrophotometry (276 nm)., Results: Albuterol delivery efficiency ranged from 0-2.89%. Median (interquartile range) and 95% CI around the median were 0.54% (0.37-1.00) and 0.50-0.63%, respectively. The coefficient of determination (R 2 ) for the model including all variables was 0.363. The 2 main contributors were percent of adapter opening (R 2 0.30) and IPV setting (R 2 0.039)., Conclusions: Albuterol delivery during invasive mechanical ventilation via in-line IPV in a pediatric lung model was inefficient. Alternative methods of delivering bronchodilators and other inhaled medications should be considered when IPV is used., (Copyright © 2023 by Daedalus Enterprises.)

BACKGROUND: Continuous high-frequency oscillation (CHFO) creates a pressure gradient in the small airways that accelerates expiratory flow. The intended use of CHFO therapy is to facilitate secretion removal and treat atelectasis. Our objective was to assess the feasibility, safety, and efficacy of CHFO in the mechanically ventilated pediatric population. METHODS: After institutional review board approval, we retrospectively reviewed medical records of mechanically ventilated children treated with CHFO (the MetaNeb system) at our institution from July 1,2007 through August 31,2012. Patients supported with extracorporeal membrane oxygenation were excluded. We evaluated changes in ventilator settings in subjects with ventilator data documented within 6h pre- and post-treatment. We evaluated arterial blood gas (ABG) results for individual treatments, comparing ABG results within 8 h pre-therapy to ABG results within 3 h post-treatment. Oxygen index and ... were calculated. Demographic data, blood pressure, heart rate, and development of new air leak while being treated with CHFO were recorded. Pre- and post-CHFO measurements were compared using Wilcoxon signed-rank testing. RESULTS: Our cohort included 59 invasively ventilated subjects. Median age was 2 y (range 1 month to 19 y), and median weight was 14 kg (2-81 kg). We evaluated data on 528 total treatments (range per subject 1-39 treatments). Peak inspiratory pressure significantly decreased with CHFO, whereas other parameters, including ... and breathing frequency, remained stable. There was no significant change in systolic blood pressure, diastolic blood pressure, or heart rate following treatment with CHFO. One subject (2%) developed a clinically insignificant pneumothorax during CHFO. CONCLUSIONS: CHFO is feasible and seems safe in our cohort of mechanically ventilated pediatric subjects. The rate of pneumothorax was consistent with that seen in similar pediatric ICU populations. These preliminary results suggest that CHFO may be beneficial by improving lung compliance in pediatric subjects with secretion-induced atelectasis. Prospective clinical studies are needed to further evaluate the clinical efficacy and safety of CHFO in children receiving invasive mechanical ventilation [ABSTRACT FROM AUTHOR]

BACKGROUND: Previous bench studies suggest that dynamic hyperinflation may occur if intrapulmonary percussive ventilation (IPV) is superimposed on mechanical ventilation in volume controlled continuous mandatory ventilation (VC-CMV) mode. We tested the hypothesis that pressure controlled continuous mandatory ventilation (PC-CMV) can protect against this risk. METHODS: An ICU ventilator was connected to an IPV device cone adapter that was attached to a lung model (compliance 30 mL/cm H2O, resistance 20 cm H2O/L/s). We measured inspired tidal volume (VTI) and lung pressure (Plung). Measurements were first taken with IPV off and the ICU ventilator set to VC-CMV or PC-CMV mode with a targeted VTI of 500 mL. For each mode, an inspiratory time (TI of 0.8 or 1.5 s and PEEP 7 or 15 cm H2O were selected. The experiments were repeated with the IPV set to either 20 or 30 psi. The dependent variables were differences in VTI (ΔVTI) and Plung with IPV off or on. The effect of VC-CMV or PC-CMV mode was tested with the ICU ventilators for TI, PEEP, and IPV working pressure using repeated measures of analysis of variance. RESULTS: At TI 0.8 s and 20 psi, ΔVTI was significantly higher in VC-CMV than in PC-CMV. PEEP had no effect on ΔVTI. At TI 1.5 s and 20 psi and at both TI values at each psi, mode and PEEP had a significant effect on ΔVTI. With the ICU ventilators at TI 1.5 s, PEEP 7 cm H2O, and 30 psi, ΔVTI (mean ± SD) ranged from -2 7 ± 25 to -176 ± 6 mL in PC-CMV and from 258 ± 369 to 369 ± 16 mL in VC-CMV. The corresponding ranges were -15 ± 17 to -62 ± 68 mL in PC-CMV and 26 ± 21 to 102 ± 95 mL in VC-CMV at TI 0.8 s, PEEP 7 cm H2O , and 20 psi. Similar findings pertained to Plung. CONCLUSIONS: When IPV is added to mechanical ventilation, the risk of hyperinflation is greater with VC-CMV than with PC-CMV. We recommend using PC-CMV to deliver IPV and adjusting the trigger variable to avoid autotriggering. [ABSTRACT FROM AUTHOR]

Mechanically ventilated patients in respiratory failure often require adjunct therapies to address special needs such as inhaled drug delivery to alleviate airway obstruction, treat pulmonary infection, or stabilize gas exchange, or therapies that enhance pulmonary hygiene. These therapies generally are supportive in nature rather than curative. Currently, most lack high-level evidence supporting their routine use. This overview describes the rationale and examines the evidence supporting adjunctive therapies during mechanical ventilation. Both mechanistic and clinical research suggests that intrapulmonary percussive ventilation may enhance pulmonary secretion mobilization and might reverse atelectasis. However, its impact on outcomes such ICU stay is uncertain. The most crucial issue is whether aerosolized antibiotics should be used to treat ventilator-associated pneumonia, particularly when caused by multi-drug resistant pathogens. There is encouraging evidence from several studies supporting its use, at least in individual cases of pneumonia non-responsive to systemic antibiotic therapy. Inhaled pulmonary vasodilators provide at least short-term improvement in oxygenation and may be useful in stabilizing pulmonary gas exchange in complex management situations. Small uncontrolled studies suggest aerosolized heparin with N-acetylcysteine might break down pulmonary casts and relieve airway obstruction in patients with severe inhalation injury. Similar low-level evidence suggests that heliox is effective in reducing airway pressure and improving ventilation in various forms of lower airway obstruction. These therapies generally are supportive and may facilitate patient management. However, because they have not been shown to improve patient outcomes, it behooves clinicians to use these therapies parsimoniously and to monitor their effectiveness carefully. [ABSTRACT FROM AUTHOR]

BACKGROUND: Despite potential benefits of intrapulmonary percussive ventilation (IPV) in various respiratory diseases, the impact of setting parameters on the mechanical effects produced by IPV in the lungs is unknown. We hypothesized that changing the parameters on IPV would modulate these effects. This in vitro study aimed at comparing the changes in intrapulmonary effects resulting from changes in parameters in 3 portable IPV devices (IMP2, Impulsator, and Pegaso). METHODS: Parameters were set in 72 combinations of frequency (90-250 cycles/min), inspiratory to expiratory (I/E) time ratio (from 1/2 to 3/1), and pressure (10-60 cm H2O). Four resulting effects were recorded on a test lung via a pneumotachometer: the expiratory to inspiratory flow ratio (E/I flow ratio), the PEEP, the ventilation, and the percussion. Percussion was assessed by the end-slope of the pressure curve. Analysis of variance was used for data analysis. RESULTS: E/I flow ratio increased with increasing I/E time ratio (P < .001). The Pegaso produced the lowest E/I flow ratio. PEEP raised 6 cm H2O in both IMP2 and Impulsator, and 17 cm H2O in the Pegaso with increasing frequency (P < .01), pressure, and I/E time ratio (P < .001). In all devices, ventilation increased with increasing pressure and decreasing frequency (P < .001). Percussion increased with increasing frequency and decreasing I/E time ratio (P < .001), and with increasing pressure when I/E time ratio was 1/1 or less. The Pegaso provided the poorest percussion. CONCLUSIONS: This study suggests that changing the parameters considerably modulates the mechanical effects produced by portable IPV devices in the lungs. Increasing frequency increased PEEP and percussion, but decreased ventilation. Increasing I/E time increased PEEP and E/I flow ratio, and decreased percussion. Finally, increasing pressure increased PEEP and ventilation. The Pegaso produced the highest PEEP, least percussion, and smallest... [ABSTRACT FROM AUTHOR]

With the recent increased use of noninvasive ventilation, the prognoses of children with neuromuscular disease has improved significantly. However, children with muscle weakness remain at risk for recurrent respiratory infection and atelectasis. We report the case of a young girl with type 1 spinal muscular atrophy who was dependent on noninvasive ventilation, and in whom conventional secretion-clearance physiotherapy became insufficient to clear secretions. We initiated high-frequency chest-wall oscillation (HFCWO) as a rescue therapy, and she had improved self-ventilation time. This is the first case report of HFCWO for secretion clearance in a severely weak child with type 1 spinal muscular atrophy. In a patient with neuromuscular disease and severe respiratory infection and compromise, HFCWO can be used safely in combination with conventional secretion-clearance physiotherapy. [ABSTRACT FROM AUTHOR]

BACKGROUND: Treatment of bronchiectasis includes drugs, oxygen therapy, and bronchial-clearance maneuvers. OBJECTIVE: To assess the safety and efficacy of intrapulmonary percussive ventilation (IPV) compared to traditional standard chest physical therapy in patients with bronchiectasis and productive cough. METHODS: In a randomized crossover study, 22 patients underwent, on consecutive days, IPV and chest physical therapy. Before each treatment session, immediately after the session, 30 min after the session, and 4 hours after the session we measured SpO2, heart rate, respiratory rate, and (with a visual analog scale) the patient's subjective sensation of phlegm encumbrance and dyspnea. Immediately after each treatment session we also measured (via visual analog scale) the patient's discomfort. We also measured the volume and wet and dry weight of collected sputum. RESULTS: No adverse effects were so severe as to require discontinuation of treatment, and the incidence of adverse effects was similar in the groups (27%). Heart rate (P = .002) and respiratory rate (P = .047) decreased during treatment, and sensation of phlegm encumbrance improved (P = .03) with both treatments. Only IPV improved (P = .004) the sensation of dyspnea. The patients found IPV more comfortable than our traditional standard chest physical therapy (P = .03). Both treatments caused important phlegm production, but there were no differences in sputum volume, wet weight, or dry weight. CONCLUSIONS: In patients with bronchiectasis and productive cough, short-term IPV was as safe and effective as traditional chest physical therapy, with less discomfort. [ABSTRACT FROM AUTHOR]

Abstract: Purpose: The aims of this prospective study were (1) to select, after weaning and extubation, chronic obstructive pulmonary disease (COPD) patients with expiratory flow limitation (EFL) measured by the negative expiratory pressure method and (2) to assess, in these patients, the short-term (30 minutes) physiologic effect of a session of intrapulmonary percussive ventilation (IPV). Materials and Methods: All COPD patients who were intubated and needed weaning from mechanical ventilation were screened after extubation. The patients were placed in half-sitting position and breathed spontaneously. The EFL and the airway occlusion pressure after 0.1 second (P0.1) were measured at the first hour after extubation. In COPD patients with EFL, an IPV session of 30 minutes was promptly performed by a physiotherapist accustomed to the technique. Expiratory flow limitation, gas exchange, and P0.1 were recorded at the end of the IPV session. Results: Among 35 patients studied after extubation, 25 patients presented an EFL and were included in the study. Intrapulmonary percussive ventilation led to a significant improvement in EFL, respectively, before and 30 minutes after IPV (65.4 ± 18.2 vs 35.6 ± 22.8; P < .05). Three patients were not expiratory flow limited after IPV. Intrapulmonary percussive ventilation led to a significant decrease in P0.1 (3.9 ± 1.6 vs 2.8 ± 1.1; P < .05). Thirty minutes of IPV led to a significant increase in Pao 2 and pH and a decrease in Paco 2 and respiratory rate (P < .05). Conclusion: In COPD patients, a session of IPV allowed a significant reduction of EFL and of P01 and a significant improvement of gas exchange. [Copyright &y& Elsevier]

Background: Chest physiotherapy has been used for many years to assist in the removal of abnormal viscid bronchial secretions in cystic fibrosis (CF) patients. Objectives:This study compared the short-term effects of two physiotherapy regimens in patients with CF: autogenic drainage (AD) preceded by either saline inhalation (‘salineNEB + AD’) or by intrapulmonary percussive ventilation (IPV) with saline (‘salineIPV + AD’). Methods: In a randomized crossover design, 20 clinically stable CF patients with similar pulmonary function at baseline received either ‘salineNEB + AD’ or ‘salineIPV + AD’ on 2 consecutive days. Transcutaneous oxygen saturation, heart rate, Borg dyspnea score and mucus wet weight were evaluated after 15 min of either salineNEB or salineIPV, and after a subsequent 30 min of AD. Results: There were no significant changes in oxygen saturation, heart rate or Borg score at any point of either physiotherapy intervention. There was no significant difference in sputum wet weight recovered with either salineNEB (2.2 ± 1.8 g, mean ± SD) or salineIPV (1.7 ± 1.9 g) alone. Subsequent AD did produce significantly greater amounts of sputum wet weight (p < 0.0001 for both) than in the initial saline delivery period, yet the amount of wet weight was similar irrespective of whether AD was preceded by salineNEB (9.7 ± 6.5 g) or salineIPV (11.6 ± 7.3 g). Conclusions: Recovered sputum weight is similar whether AD is preceded by salineNEB or salineIPV. The much greater amount of mucus obtained during the AD period than during the saline delivery period warrants further investigation. Copyright © 2007 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

Background: Persistent atelectasis in children is lacking a gold standard treatment. Intrapulmonary percussive ventilation (IPV) is presented as a promising chest physiotherapy technique in the treatment of atelectasis. This study aimed to follow the evolution of atelectasis resolution with noninvasive IPV in young children and to detect eventual adverse effects. Methods: Six children were hospitalized for respiratory distress with suspicion of atelectasis. A 15 min IPV treatment was immediately started at D1 twice a day for 5 days. Children were free of any other treatment. Chest X-Ray (CXR) was performed on the second day (D2) and was repeated 3 days later (D5). After the study, CXR were retrospectively reviewed by three specialists who had no knowledge of the clinical observations of the patients. They were asked to assess atelectasis by a score between 4 (complete collapse) and 0 (complete resolution). A clinical score on a maximum of 4 points was assessed by appetite deterioration, dyspnoea, mucus production and cough presence at D1 and D5 (1 point per symptom present). Paired t-test compared D1 and D5 results. Results: All patients returned home after 5 days IPV. SpO2 normalized (93.2 ± 0.8 to 95.3 ± 0.8; P = 0.002) and patients all improved clinically (score, 2.8 ± 0.9 to 0.8 ± 0.6; P < 0.05). Out of four patients with radiographic evidence of atelectasis, three improved their atelectasis score. Conclusions: No side-effect or adverse effect was observed during IPV treatments. IPV was safe and effective in atelectasis resolution in 3/4 of the cases. Patients all recovered a stable clinical state. CXR improved in 4/5 children. They were all discharged home after 5 days of IPV treatment. [ABSTRACT FROM AUTHOR]

Summary: Clearance of infected airway secretions is essential to preserve lung function in patients with cystic fibrosis (CF). Although the value of regular airway clearance treatments has been shown in many studies, adherence to the prescribed treatments is not very good (see Making airway clearance successful, pp. 000–000). In the past the only method available was conventional chest physiotherapy (CCPT; also known as manual percussion and postural drainage). CCPT remains the ‘gold standard’ of airway clearance methods and may be the best choice for some patients, such as infants and young children. However, the many newer methods of airway clearance available now allow CF patients and their families to choose the techniques and devices that best suits them. Most of the newer airway clearance devices have been studied in comparison to standard chest physiotherapy and most studies show no advantage of one method over another. This review will describe newer airway clearance devices available for CF patients and discuss evidence for the effectiveness of these devices compared to standard chest physiotherapy. [Copyright &y& Elsevier]

Abstract: Purpose: To investigate the efficacy and safety of intrapulmonary percussive ventilation (IPV) in obese patients, we assessed their respiratory and hemodynamic functions during IPV superimposed on conventional ventilation. Materials and Methods: Ten obese patients with acute respiratory failure due to compression atelectasis who had not improved by conventional ventilation were treated with IPV. Hemodynamic parameters, ventilator settings, and intracranial pressure (n = 1) were recorded every hour. Arterial blood gas was analyzed every 3 hours. The efficacy and safety of IPV was assessed at the start of weaning. Results: Before IPV, Pao 2/Fio 2 ratio remained low (189 ± 63 mm Hg), which significantly increased to 243 ± 67 mm Hg at 3 hours from the initiation of IPV (P < .01). Furthermore, it continuously increased to 280 ± 50 mm Hg at 24 hours (P < .01). Intrapulmonary percussive ventilation induced significant increase in dynamic compliance from control value of 30 ± 8 mL/cm H2O at 0 hours to 35 ± 9 mL/cm H2O at 12 hours (P < .05) and to 38 ± 8 mL/cm H2O at 24 hours (P < .01). Heart rate and mean arterial pressure were not significantly changed during IPV. Improvement of compression atelectasis was confirmed by their chest computed tomographic scans. Adverse effects such as pneumothorax and intracranial hypertension were not seen. Conclusions: These results demonstrated that IPV was effective and safe in improving compression atelectasis without adverse effects in obese patients. [Copyright &y& Elsevier]

Summary: Intrapulmonary percussive ventilation (IPV) is a ventilatory technique that delivers bursts of high-flow respiratory gas into the lung at high rates, intended for treating acute respiratory failure and for mobilization of secretions. We performed a study, aimed at assessing the physiological response to IPV, on patients’ breathing pattern, inspiratory effort, lung mechanics and tolerance to ventilation. Ten COPD patients underwent randomized trials of IPV through a face mask at different pressure/frequency combinations (1.2bar/250cycles/min; 1.8/250; 1.2/350; 1.8/350), separated by return to baseline (SB), using the IMP2 ventilator. In 5 patients we have also compared the physiological changes of IPV with those obtained during pressure support ventilation (PSV). Minute ventilation did not vary among the trials, but tidal volumes (V T) were significantly greater during 1.2/250, 1.2/350 and 1.8/350 compared to SB. The pressure time product of the diaphragm per minute (PTPdi/min) estimate of the diaphragm oxygen expenditure was also significantly reduced during 1.2/250 and 1.8/250 (209cmH2O×s/min for SB vs. 143 and 125 for 1.2/250 and 1.8/250, respectively P<0.05), as well as dynamic intrinsic end-expiratory pressure (PEEPi,dyn). Similar reduction in PTPdi/min were obtained also during PSV. Tolerance to ventilation and oxygen saturation were satisfactory and did not change during the different trials. In 5 normal subjects a prolonged apnea trial lasting >2min was also performed, without any significant decrease in SaO2 or subjective discomfort. In conclusion, IPV was able to guarantee an adequate ventilation, while inducing a significant unloading of the diaphragm during the “low-frequency” trials. [Copyright &y& Elsevier]

Compares in vitro and in vivo characteristics of the nebulizer of the intrapulmonary percussive ventillation (IPV) device from Percussionaire Corp., based in Sandpoint, Idaho, with those of standard jet nebulization from Medic-Aid, based in West Sussex, Great Britain. Observation that both techniques showed comparable lung deposition despite a large difference in particle size but IPV intrapulmonary deposition was too variable.