Under the scoring system, a CWI of 0 denoted no visible or tactile thorax oscillations a CWI score of 1 showed upper bilateral thorax oscillations a CWI score of 2 indicated upper and bibasilar thorax oscillations. We developed a chest wiggle index (CWI) score to assist therapists in assessing optimal treatment strategies. In our study, the efficacy of the therapy was determined by visible and tactile bilateral chest oscillations. Cost of the device ranges from $1,500 to $3,500.
IPV is a combination therapy including components of incentive spirometry, hydration, bronchodilators, oscillatory PEP and positive inspiratory airway pressure.
The clinician controls the amount of pressure and pulsatile flow by adjusting frequency and drive pressure. IPV THERAPY uses a device delivering positive percussive inspiratory/expiratory pressure which is not dependent on patient effort. In effect, the device is an oscillating PEP valve. The degree of chest wiggle and expiratory pressure is highly dependent on patient effort. This vibrates the bronchial walls and may help loosen secretions. If the patient exhales at a constant high flow, a steel ball in the pipe bowl oscillates and modulates a pressure gradient in the airway. The Flutter valve is a small hand-held, pipe-like device that capitalizes on a patient’s ability to generate relatively high expiratory flows over several seconds. Ten patients with either thick inspissated secretions and/or atelectasis were included in the study. WITH THAT THOUGHT in mind, Montana clinicians set up a study comparing IPV and the Flutter device to determine the ability of the two devices to cause bilateral basal chest oscillations. While some studies have compared traditional, external CPT with some of the new equipment designed to start the process internally, to our knowledge, no study has previously been done to compare patient results using two of the newer devicesthe Flutter valve and IPV therapy. Proponents of each device strongly champion their own method. Among the devices used for this technique are PEP valve, Flutter valve and Intrapulmonary Percussive Ventilation (IPV). Recently, airway clearance techniques using internal assaults have been introduced to the respiratory care community. In some instances, it may not even be all that beneficial either, because extrathoracic assaults to the chest wall do not always allow vibrations to be transmitted to the lung parenchyma where it is needed. 1 shows CPT has only a short list of indications and may even be harmful. However, an extensive review of CPT by Eid et al. Acapella's performance is not gravity-dependent (ie, dependent on device orientation) and may be easier to use for some patients, particularly at low expiratory flows.Traditionally, chest physical therapy (CPT) has been used in patients with diseases associated with production of copious secretions and atelectasis. At 5 L/min the Acapella produced a more stable waveform, with a lower frequency, higher amplitude, and a slightly wider range of PEP than the Flutter.Īcapella and Flutter have similar performance characteristics. Both devices produced similar pressure waveforms at the medium flows. However, the differences were relatively small and may not be clinically important. There were statistically significant differences between the devices for mean pressure, pressure amplitude, and frequency, for all experimental conditions. Data were analyzed by 2-way repeated measures analysis of variance, and differences were considered significant when p was < 0.05. The devices were adjusted to give low, medium, and high mean expiratory pressure (Flutter angle at 0, 20, and 40 degrees Acapella by dial setting). The pressure waveform for 1 second was also graphically displayed and recorded. Values for frequency, peak, trough, and mean pressure were recorded automatically every 3 seconds at flows of 5, 10, 15, 20, 25, and 30 L/min. We measured oscillatory amplitude, PEP, and frequency. We hypothesized that the Acapella and Flutter would produce similar mean PEP, oscillatory pressure amplitude, and frequency over a clinically relevant range of flows. The Acapella comes in 2 models: one for patients with expiratory flow > or = 15 L/min and one for < or = 15 L/min. A new device, the Acapella, uses a counterweighted plug and magnet to create air flow oscillation. In the Flutter a steel ball vibrates inside a cone, causing air flow vibration. Oscillatory positive expiratory pressure (PEP) with the Flutter device facilitates secretion removal.