High-Frequency Percussive Ventilation as a Salvage Modality in Adult Respiratory Distress Syndrome: A Preliminary Study

Paulsen SM, Killyon GW, Barillo DJ. High-Frequency Percussive Ventilation as a Salvage Modality in Adult Respiratory Distress Syndrome: A Preliminary Study. The American Surgeon; October 2002.

“Seven of ten patients failing conventional ventilation survived to hospital discharge after salvage therapy with HFPV. We advocate further studies of HFPV in non-burn patients with ARDS both as salvage therapy and as replacement for conventional ventilation for the initial treatment for ARDS.”

High-frequency Percussive Ventilation Improves Oxygenation in Patients with ARDS

Velmahos GC, Chan LS, Tatevossian R, et al. High-frequency Percussive Ventilation Improves Oxygenation in Patients with ARDS. Clinical Investigators in Critical Care. 1999; August.

“In summary, it appears that in selected patients, HFPV can improve oxygenation with reduced peak airway pressures, potentially reducing the risk of barotrauma. This improvement can be achieved without elevations of CO2 or deterioration of hemo-dynamic parameter values. The improved clearance of pulmonary secretions may reduce the risk of intrathoracic infection. Further studies are justified to define the population that can be maximally benefited by this method.”

Use of HFPV for Adults with ARDS Treated with ECMO

Michaels AJ, Hill JG, Sperley BP, et al. Use of HFPV for Adults with ARDS: The Protocolized Use of High-Frequency Percussive Ventilation for Adults with Acute Respiratory Failure Treated with Extracorporeal Membrane Oxygenation. ASAIO Journal. 2015; Pulmonary 345- 349. DOI: 10.1097/MAT.0000000000000196

“A unique sliding piston called a Phasitron regulates both the percussive and convective components. This provides a combination of diffusive intrapulmonary gas mixing because of of the percussive feature…”

“The ability of this ventilator to mobilize secretions and recruit alveoli, coupled with minimizing regional over-distention and ventilation induced lung make it an optimal choice for ventilating patients with injured and variably compliant lungs.”

“This report suggests that the time required for adults with ARDS to recover and wean from ECMO may be reduced by the protocolized use of HFPV and an active strategy of lung recruitment.”

High-frequency percussive ventilation in severe acute respiratory distress syndrome: A single center experience

Spapen H, Borremans M, Diltoer M, Van Gorp V, Nam Nguyen D, Honore P. High-frequency percussive ventilation in sever acute respiratory distress syndrom: A single center experience. J Anaesthesiol Clin Pharmacol. 2014 Jan-Mar; 30(1): 65-70. DOI:10.4103/0970-9185.125706

“HFPV caused rapid and sustained improvement in oxygenation and ventilation.”

High-frequency Percussive Ventilation Improves Oxygenation and Ventilation in Pediatric Patients with Acute Respiratory Failure

Rizkalla NA, Dominick CL, Fitzgerald JC, Thomas NJ, Yehya N. High-frequency percussive ventilation improves oxygenation and ventilation in pediatric patients with acute respiratory failure. Journal of Crit Care.2014; 29:314e1-314e7. http://dx.doi.org/10.1016/j.jcrc.2013.11.009

“In heterogeneous population of pediatric ARF failing conventional ventilation, HFPV efficiently improves gas exchange in a lung-protective manner.”

Adult refractory hypoxemic acute respiratory distress syndrome treated with extracorporeal membrane oxygenation: the role of a regional referral center

Michaels A.J. MD, Hill J.G. MD, Long W.B. MD, Young B.P MD, Sperley B.P. DO, Shanks T.R. RN, et al.  Adult refractory hypoxemic acute respiratory distress syndrome treated with extracorporeal membrane oxygenation: the role of a regional referral center. The American Journal of Surgery. 2013. Retrieved from http://dx.doi.org/10.1016/j.amjsurg.2013.01.025

“ECMO provides support that prevents ventilator-induced lung injury while the lungs heal. The investigators present a series of 36 adults with refractory hypoxemic ARDS (ratio of partial pressure of oxygen to fraction of inspired oxygen <50) from 17 different facilities who, treated with ECMO at a single referral center, had a 60% survival rate.”

High Frequency Percussive Ventilation Improves Short Term Survival in ARDS Sheep Model

Wang D. MD, Zwischenberger J.B. MD, Savage C. MD, Miller L. MD, Deyo D.J. DVM, Alpard S. BA, Cardenas V.J. Jr. High Frequency Percussive Ventilation With Systemic Heparin Improves Short-Term Survival in a LD100 Sheep Model of Acute Respiratory Distress Syndrome. American Burn Association. 2006. DOI: 10.109//01.BCR.0000226003.18885.E8

An assessment of HFPV (high frequency percussive ventilation) and “systematic heparin on survival in our LD100 sheep model of smoke/burn induced ARDS” shows that “Survival 84 hours after smoke and burn injury was significantly greater in the HFPV compared with the VCMV group.”

High Frequency Percussive Ventilation in the Pediatric ICU

Giordana R. RRT-NPS. High Frequency Percussive Ventilation in the Pediatric ICU. Case Study  2. American Association for Respiratory Care’s Neonatal Pediatrics Bulletin. Summer 2012.

“The case describes the application of HFPV for lung recruitment, secretion mobilization, and ventilation in a patient with severe asthma.”

“Immediately following the bronchoscopy the decision was made to place the patient on HFPV. Over a period of three hours we saw significant improvement in his saturations and were able to wean his oxygen supplementation from 100% to 30%; he was off nitric oxide within eight hours. The patient remained on HFPV for two days and was successfully extubated to a nasal cannula the next day.”

High-frequency percussive ventilation and low tidal volume ventilation in burns: A randomized controlled trial

Chung KK, Wolf SE, Renz EM, et al. High-frequency percussive ventilation and low tidal volume ventilation burns: A randomized controlled trial. Crit Care Med. 2010; Vol 38 (10).

“In our institution, many clinicians favored HFPV; this was manifested during the conduct of the trial because three patients in the LTV arm were switched to HFPV off protocol based largely on attending presence.”

High-frequency percussive ventilation for intercontinental aeromedical evacuation

Barillo DJ, Renz EM, Renz EM, et al. High-frequency percussive ventilation for intercontinental aeromedical evacuation. American Journal of Disaster Medicine. 2011; Vol 6 (6): 369-378. DOI: 10.5055/ajdm.2011.0075

“The availability of HFPV in this setting has extended the benefits of rapid evacuation to patients who would have previously been non transportable.”

“HFPV is safe and efficacious for transcontinental flight when used by an experienced medical transport team.”

High-frequency Percussive Ventilation for Severe Inhalation Injury

Hiller K.N. MD, Morgan C.K. MD. High-frequency Percussive Ventilation for Severe Inhalation Injury. Anesthesiology. 2014:120(4).

A case study of a healthy 26 year old intubated after a house fire diagnosed with singed nares, carbonaceous tracheal secretions, and respiratory distress in addition to soot throughout the tracheobronchial tree consistent with severe inhalational injury. When conventional ventilation and medical practices resulted in worsened oxygenation and ventilation, HFPV was initiated.

“Because inhalation injury is predominantly a conducting and peripheral airway insult, HFPV may preferentially benefit these specific patients.”

Burn Center Treatment of Patients With Severe Anhydrous Ammonia Injury: Case Reports and Literature Review

White C.E. MD, Park M.S. MD, Renz E.M MD, Kim S.H. MD, Ritenour A.E. MD, Wolf S.E. MD, et al. Burn Center Treatment of Patients With Severe Anhydrous Ammonia Injury: Case Reports and Literature Review. American Burn Association. 2007.DOI: 10.1097/BCR.0b013e318159a44e

“Anhydrous ammonia (NH3) is a widespread industrial chemical, used in the fertilizer, refrigeration, petroleum, and explosive industries…. When exposed to water on the skin, in the eyes, or in the aero digestive tract, it forms ammonium hydroxide (NH4). This strong base is in turn responsible for the majority of the resultant damage. Because ammonia is a common cause of accidents involving toxic industrial chemicals, and because it could be used as a weapon of opportunity by terrorists or during armed conflict, familiarity with these injuries is important.”

“High frequency percussive ventilation using the VDR-4, which was also used in the care of these patients, is likely useful for clearing necrotic debris from the smaller airways.”

Recent advances in burn care

Yowler CJ. Recent advances in burn care. Current Opinion in Anesthesiology. 2001; 14:251-255.

“Inhalation injury is the most common cause of death at the scene of a fire, and pneumonia in victims of smoke inhalation is the most common etiology of death after hospital admission.”

“Several techniques show promise in improving outcome after smoke inhalation. High-frequency percussive ventilation, first described in patients with inhalation injury… also appears to be an effective treatment for the reduction of pulmonary morbidity in pediatric patients.”

Effect of Intrapulmonary percussive ventilation on expiratory flow limitation in chronic obstructive pulmonary disease patients

Vargas F, Boyer A, Nam Bui H, Guenard H, Gruson D, Hilbert G. Effect of intrapulmonary percussive ventilation on expiratory flow limitation in chronic obstructive pulmonary disease patients. Journal of Crit Care. 2008. DOI:10.1016/j.jcrc.2008.02.006

“In COPD patients, a session of IPV allowed a significant reduction of EFL and of P01 and a significant improvement of gas exchange.”

Intrapulmonary percussive ventilation in acute exacerbations of COPD patients with mild respiratory acidosis: a randomized controlled trial

Vargas F., Nam Bui H., Boyer A., Salmi L.R., Gbikpi-Benissan G., Guenard H., et al. Intrapulmonary percussive ventilation in acute exacerbations of COPD patients with mild respiratory acidosis: a randomized controlled trial [ISRCTN17802078]. Critical Care. 2005. http://ccforum.com/content/9/4/R382

“IPV is a safe technique and may prevent further deterioration in patients with acute exacerbations of COPD with mild respiratory acidosis.”

This study utilizes hypothesis testing for IPV (in addition to traditional ventilation treatment methods) in acute exacerbations of COPD with mild Respiratory acidosis. Results include a significant decrease in respiratory rate, an increase in PaO2, and a decrease in PaCO2. Without the use of IPV, “exacerbation worsened in 6 out of 17 patients… versus 0 out of 16 in the IPV group.” In addition, “the hospital stay was significantly shorter in the IPV group than in the control group.”

Intrapulmonary percussive ventilation improves the outcome of patients with acute exacerbation of chronic obstructive pulmonary disease using a helmet

Antonaglia V, Lucangelo U, Zin WA, et al. Intrapulmonary percussive ventilation improves the outcome of patients with acute exacerbation of chronic obstructive pulmonary disease using a helmet. Crit Care Med. 2006; Vol. 34 No. 12

A randomized clinical trial in ICU at a university hospital of forty patients with exacerbated COPD were ventilated with a non-invasive positive pressure ventilation ‘helmet.’

“IPV treatment was feasible for all patients. Non-invasive positive-pressure ventilation by helmet associated with IPV reduces the duration of ventilator treatment and intensive care unit stay and improves gas exchange at discharge from intensive care unit in patients with sever exacerbation of COPD.”

Physiological response to intrapulmonary percussive ventilation in stable COPD patients

Nava S, Barbarito N, Piaggi G, De Mattia E, Cirio S. Physiological response to intrapulmonary percussive ventilation in stable COPD patients. Respiratory Medicine. 2006; 100, 1526-1533.

A randomized study of ten patients underwent IPV through a facemask at different pressure and frequency combinations.

The amount of “PEEPi,dyn was significantly reduced… suggesting a direct effect of IPV.” This study demonstrates that the use of IPV is associated with “a significant reduction of the diaphragm energy expenditure” The general conclusion of IPV use is that “it is safe, and overall well tolerated.”

High-frequency Percussive Ventilation for Airway Clearance in Cystic Fibrosis: A Brief Report

Dmello D, Nayak RP, Matuschak GM. High-frequency Percussive Ventilation for Airway Clearance in Cystic Fibrosis: A Brief Report. Lung. 2010. DOI:10.1007/s00408-010-9252-5

“Conventional ventilatory strategies do not address the need for aggressive airway clearance in intubated CF patients and are thus limited to endotracheal suctioning and the use of bronchodilators. In contrast, the laminar flow of gas through collateral pathways distal to the secretions in obstructed airways during HFPV results in expulsion of inspissated secretions by improving their physical and transport properties.”

Comparison of intrapulmonary percussive ventilation and chest physiotherapy: a pilot study in patients with cystic fibrosis

Homnick DN, Natale JE, Pfeifle J. Comparison of intrapulmonary percussive ventilation and chest physiotherapy: a pilot study in patients with cystic fibrosis. American College of Chest Physicians. 1994; 105: 1789-93.

“Although none of these techniques have been shown to have a therapeutic benefit over conventional P&PD, they offer the advantage of increased patient independence, overcoming a significant barrier to compliance. The is especially true for adolescents and adults with CF.”

“Participants tolerated all respiratory treatment without adverse consequences. Subjectively, participants reported no discomfort with use of IPV compared with conventional P&PD Therapy.”

“In summary, a single IPV treatment was as effective as standard chest physiotherapy in improving acute pulmonary function and enhancing sputum expectoration in ambulatory older children and adults with excellent to moderate CF severity grades. Although this study was limited to the acute effects, it serves as an important starting point for long term studies of efficacy and safety of IPV use in patients with CF.”

High-Frequency Percussive Ventilation and Bronchoscopy During Extracorporeal Life Support in Children

Yehya N, Dominick CL, Connelly JT, et al. High-Frequency Percussive Ventilation and Bronchoscopy During Extracorporeal Life Support in Children. ASAIO Journal. 2014; 60:424-428 DOI: 10.1097/MAT.0000000000000088

“Improved secretion clearance in the HFPV cohort may have led to improved pulmonary compliance at similar mPaw, leading to faster recovery and shorter ECLS durations. HFPV is also thought to improve alveolar recruitment because of more sustained mPaw throughout the ventilator cycle, as well as maintaining airway patency during expiratory oscillations.”

“The use of HFPV… was associated with more days alive and off ECLS at 30 and 60 days…”

“The use of HFPV… was independently associated with ECLS-free days.”

Adult refractory hypoxemic acute respiratory distress syndrome treated with extracorporeal membrane oxygenation: the role of a regional referral center

Michaels A.J. MD, Hill J.G. MD, Long W.B. MD, Young B.P MD, Sperley B.P. DO, Shanks T.R. RN, et al.  Adult refractory hypoxemic acute respiratory distress syndrome treated with extracorporeal membrane oxygenation: the role of a regional referral center. The American Journal of Surgery. 2013. Retrieved from http://dx.doi.org/10.1016/j.amjsurg.2013.01.025

“ECMO provides support that prevents ventilator-induced lung injury while the lungs heal. The investigators present a series of 36 adults with refractory hypoxemic ARDS (ratio of partial pressure of oxygen to fraction of inspired oxygen <50) from 17 different facilities who, treated with ECMO at a single referral center, had a 60% survival rate.”

Protocolized use of High Frequency Percussive Ventilation (HFPV) reduces time on ECMo for Adults with ARDS

Michaels AJ, Hill JG, Sperley BP, et al. Protocolized use of High Frequency Percussive Ventilation (HFPV) reduces time on ECMO for Adults with ARDS. International Journal of Artificial Organs. 36(4):268, May 2013

“The HFPV patients…were significantly more hypoxic than ELSO patients and, treated with the VDR, weaned from ECMO 40% faster and were less hypoxic at the time of recovery.”

“For survivors, HFPV patients had a lower prePF, higher postPF, and required fewer hours on ECMO.”

Use of HFPV for Adults with ARDS Treated with ECMO

Michaels AJ, Hill JG, Sperley BP, et al. Use of HFPV for Adults with ARDS: The Protocolized Use of High-Frequency Percussive Ventilation for Adults with Acute Respiratory Failure Treated with Extracorporeal Membrane Oxygenation. ASAIO Journal. 2015; Pulmonary 345- 349. DOI: 10.1097/MAT.0000000000000196

“A unique sliding piston called a Phasitron regulates both the percussive and convective components. This provides a combination of diffusive intrapulmonary gas mixing because of of the percussive feature…”

“The ability of this ventilator to mobilize secretions and recruit alveoli, coupled with minimizing regional over-distention and ventilation induced lung make it an optimal choice for ventilating patients with injured and variably compliant lungs.”

“This report suggests that the time required for adults with ARDS to recover and wean from ECMO may be reduced by the protocolized use of HFPV and an active strategy of lung recruitment.”

Pandemic Flu and the Sudden Demand for ECMO resources: A mature trauma program can provide surge capacity in acute critical care crises

Michaels AJ, Hill JG, Bliss D, et al. Pandemic flu and the sudden demand for ECMO resources: A mature trauma program can provide surge capacity in acute critical care crises. J Trauma Acute Care Surg. 2013;74(6):1493-1497

“H1N1 created a severe public health challenge for referral centers with ECMO capability. The resources of our trauma service were adapted to this non-trauma critical care crisis without disruption of other hospital services. These H1N1 patients treated with ECMO had a 67% recovery rate and a 60% survival rate. All survivors were discharged to home.”

High-Frequency Percussive Ventilation and Bronchoscopy During Extracorporeal Life Support in Children

Yehya N, Dominick CL, Connelly JT, et al. High-Frequency Percussive Ventilation and Bronchoscopy During Extracorporeal Life Support in Children. ASAIO Journal. 2014; 60:424-428 DOI: 10.1097/MAT.0000000000000088

“Improved secretion clearance in the HFPV cohort may have led to improved pulmonary compliance at similar mPaw, leading to faster recovery and shorter ECLS durations. HFPV is also thought to improve alveolar recruitment because of more sustained mPaw throughout the ventilator cycle, as well as maintaining airway patency during expiratory oscillations.”

“The use of HFPV… was associated with more days alive and off ECLS at 30 and 60 days…”

“The use of HFPV… was independently associated with ECLS-free days.”

IPV Safe for Mucus Clearance in Duchenne Muscular Dystrophy Patients

Toussaint M, De Win H, Steens M, Soudon P. Effect of Intrapulmonary Percussive Ventilation on Mucus Clearance in Duchenne Muscular Dystrophy Patients: A Preliminary Report. Respir Care. 2003; 48(10):940-947.

 The objective of the study was “to determine the effects of IPV on mucus clearance in tracheostomized Duchenne muscular dystrophy patients.” Eight patients were entered into a randomized crossover study.

For patients with hyper secretion within the standard deviation, weight of collected secretions was significantly higher than those without use of IPV.

“IPV is a safe airway clearance method for treacheostomized Duchenne muscular dystrophy patients, and this preliminary study suggests that IPV increases the effectiveness of assisted mucus clearance and techniques.”

High-frequency nasal ventilation for 21 d maintains gas exchange with lower respiratory pressures and promotes alveolarization in preterm lambs

Null DM, Albord J, Leavitt W, et al. High-frequency nasal ventilation for 21 d maintains gas exchange with lower respiratory pressures and promotes alveolarization in preterm lambs. Pediatric RESEARCH. 2014; Vol 75 (4) 507-516

“The driver for noninvasive respiratory support was a Percussionaire ventilator… This ventilator allows for a combined low-frequency conventional/high-frequecny percussive approach, whereby a conventional pressure-limited…”

“Our results suggest that long-term use of HFNV as applied in this study may be a more effective approach to non-invasive respiratory support than either nasal CPAP or nasal IMV.”

Volumetric diffusive respirator use in neonatal respiratory failure

Campbell PJ, Chilton HW, Garvey PA, Gupta JM. J. Volumetric diffusive respirator use in neonatal respiratory failure. Paediatr. Child Health.(1991) 27, 31-33.

“Six very low birthweight neonates with terminal respiratory failure due to sever hyaline membrane disease who failed to respond to conventional ventilation were offered a trial of high frequency jet ventilation using the volumetric diffusive respirator (VDR). All neonates showed improvement in pulmonary function. Two neonates were weaned successfully from high frequency ventilation. The results of this initial trial suggest that the volumetric diffusive respirator is a safe and effective method of ventilation in neonates with respiratory failure and that the survival rate in such neonates might be enhanced if treatment is introduced earlier in the disease.”

Nasal High Frequency Percussive Ventilation Versus Nasal Continuous Positive Airway Pressure in Transient Tachypnea of the Newborn

De La Roque ED, Bertrand C, Tandonnet O, et al. Nasal High Frequency Percussive Ventilation Versus Nasal Continuous Positive Airway Pressure In Transient Tachypnea of the Newborn: A Pilot Randomized Controlled Trial (NCT00556738). Pediatric Pulmonology. 2010;00:1-6.

“NHFPV is well tolerated and more effective than NCPAP in treatment of TTN. NHFPV might be a novel and safe tool to manage TTN.”

High Frequency Percussive Ventilation in the Pediatric ICU

Giordana R. RRT-NPS. High Frequency Percussive Ventilation in the Pediatric ICU. Case Study  2. American Association for Respiratory Care’s Neonatal Pediatrics Bulletin. Summer 2012.

“The case describes the application of HFPV for lung recruitment, secretion mobilization, and ventilation in a patient with severe asthma.”

“Immediately following the bronchoscopy the decision was made to place the patient on HFPV. Over a period of three hours we saw significant improvement in his saturations and were able to wean his oxygen supplementation from 100% to 30%; he was off nitric oxide within eight hours. The patient remained on HFPV for two days and was successfully extubated to a nasal cannula the next day.”

High-frequency percussive ventilation in a pediatric patient with hydrocarbon aspiration

Mabe TG, Honeycutt T, Cairns BA, Kocis KC, Short KA. High-frequency percussive ventilation in a pediatric patient with hydrocarbon aspiration. Pedatr Crit Care. 2007;8(4):383-385. DOI: 10.1097/01.PCC.0000262792.86267.F4

“In this case, HFPV used as an alternative mode of ventilation successfully mobilized secretions that were otherwise unobtainable and that we believe led to the swift recovery of this child. HFPV should be given consideration as a mode of ventilation when mobilization of secretions is an issue.”

High-Frequency Percussive Ventilation and Bronchoscopy During Extracorporeal Life Support in Children

Yehya N, Dominick CL, Connelly JT, et al. High-Frequency Percussive Ventilation and Bronchoscopy During Extracorporeal Life Support in Children. ASAIO Journal. 2014; 60:424-428 DOI: 10.1097/MAT.0000000000000088

“Improved secretion clearance in the HFPV cohort may have led to improved pulmonary compliance at similar mPaw, leading to faster recovery and shorter ECLS durations. HFPV is also thought to improve alveolar recruitment because of more sustained mPaw throughout the ventilator cycle, as well as maintaining airway patency during expiratory oscillations.”

“The use of HFPV… was associated with more days alive and off ECLS at 30 and 60 days…”

“The use of HFPV… was independently associated with ECLS-free days.”

High-frequency Percussive Ventilation Improves Oxygenation and Ventilation in Pediatric Patients with Acute Respiratory Failure

Rizkalla NA, Dominick CL, Fitzgerald JC, Thomas NJ, Yehya N. High-frequency percussive ventilation improves oxygenation and ventilation in pediatric patients with acute respiratory failure. Journal of Crit Care.2014; 29:314e1-314e7. http://dx.doi.org/10.1016/j.jcrc.2013.11.009

“In heterogeneous population of pediatric ARF failing conventional ventilation, HFPV efficiently improves gas exchange in a lung-protective manner.”

Recent advances in burn care

Yowler CJ. Recent advances in burn care. Current Opinion in Anesthesiology. 2001; 14:251-255.

“Inhalation injury is the most common cause of death at the scene of a fire, and pneumonia in victims of smoke inhalation is the most common etiology of death after hospital admission.”

“Several techniques show promise in improving outcome after smoke inhalation. High-frequency percussive ventilation, first described in patients with inhalation injury… also appears to be an effective treatment for the reduction of pulmonary morbidity in pediatric patients.”

Comparison of intrapulmonary percussive ventilation and chest physiotherapy: a pilot study in patients with cystic fibrosis

Homnick DN, Natale JE, Pfeifle J. Comparison of intrapulmonary percussive ventilation and chest physiotherapy: a pilot study in patients with cystic fibrosis. American College of Chest Physicians. 1994; 105: 1789-93.

“Although none of these techniques have been shown to have a therapeutic benefit over conventional P&PD, they offer the advantage of increased patient independence, overcoming a significant barrier to compliance. The is especially true for adolescents and adults with CF.”

“Participants tolerated all respiratory treatment without adverse consequences. Subjectively, participants reported no discomfort with use of IPV compared with conventional P&PD Therapy.”

“In summary, a single IPV treatment was as effective as standard chest physiotherapy in improving acute pulmonary function and enhancing sputum expectoration in ambulatory older children and adults with excellent to moderate CF severity grades. Although this study was limited to the acute effects, it serves as an important starting point for long term studies of efficacy and safety of IPV use in patients with CF.”

Use of Intrapulmonary Percussive Ventilation (IPV) in the Management of Pulmonary Complications of an Infant with Osteogenesis Imperfecta

Nino G. MD, McNally P. MBBCh, Miske L.J. RN, MSN, Hickey E. MSN, CRNP, Panitch H.B. MD. Use of Intrapulmonary Percussive Ventilation (IPV) in the Management of Pulmonary Complications of an Infant With Osteogenesis Imperfecta. Pediatric Pulmonology. 2009; 44: 1151-1154

“Osteogenesis imperfect (OI) is a genetic disorder characterized by abnormal collagen formation and short stature. These patients present with frequent vertebral, rib, and longbone fractures. There are many respiratory complications associated with OI including pneumonia,the most common cause of mortality in the severe forms of the disease. We present a case of an infant with OI (type III/IV) and significant tracheobronchomalacia who had required multiple hospitalizations for recurrent atelectasis and respiratory failure in the setting of acute respiratory infections. External chest percussion and vibration were avoided because of the risk of rib fractures. Intrapulmonary percussive ventilation (IPV) was initiated during an acute illness with good effect, and continued successfully after discharge from hospital. We conclude that IPV represents a safe and effective alternative to airway clearance in infants with OI.”

Use of HFPV for Adults with ARDS Treated with ECMO

Michaels AJ, Hill JG, Sperley BP, et al. Use of HFPV for Adults with ARDS: The Protocolized Use of High-Frequency Percussive Ventilation for Adults with Acute Respiratory Failure Treated with Extracorporeal Membrane Oxygenation. ASAIO Journal. 2015; Pulmonary 345- 349. DOI: 10.1097/MAT.0000000000000196

“A unique sliding piston called a Phasitron regulates both the percussive and convective components. This provides a combination of diffusive intrapulmonary gas mixing because of of the percussive feature…”

“The ability of this ventilator to mobilize secretions and recruit alveoli, coupled with minimizing regional over-distention and ventilation induced lung make it an optimal choice for ventilating patients with injured and variably compliant lungs.”

“This report suggests that the time required for adults with ARDS to recover and wean from ECMO may be reduced by the protocolized use of HFPV and an active strategy of lung recruitment.”

High-frequency Percussive Ventilation for Airway Clearance in Cystic Fibrosis: A Brief Report

Dmello D, Nayak RP, Matuschak GM. High-frequency Percussive Ventilation for Airway Clearance in Cystic Fibrosis: A Brief Report. Lung. 2010. DOI:10.1007/s00408-010-9252-5

“Conventional ventilatory strategies do not address the need for aggressive airway clearance in intubated CF patients and are thus limited to endotracheal suctioning and the use of bronchodilators. In contrast, the laminar flow of gas through collateral pathways distal to the secretions in obstructed airways during HFPV results in expulsion of inspissated secretions by improving their physical and transport properties.”

High-Frequency Percussive Ventilation as a Salvage Modality in Adult Respiratory Distress Syndrome: A Preliminary Study

Paulsen SM, Killyon GW, Barillo DJ. High-Frequency Percussive Ventilation as a Salvage Modality in Adult Respiratory Distress Syndrome: A Preliminary Study. The American Surgeon; October 2002.

“Seven of ten patients failing conventional ventilation survived to hospital discharge after salvage therapy with HFPV. We advocate further studies of HFPV in non-burn patients with ARDS both as salvage therapy and as replacement for conventional ventilation for the initial treatment for ARDS.”

High Frequency Percussive Ventilation in the Management of Acute Asthma

Kodali L, Klada E, Bansal R, Esan A, Khusid F, Raoof S. High Frequency Percussive Ventilation in the Management of Acute Asthma. CHEST J, 2011  Vol. 140, No. 4 (Meeting Abstracts).

“The subsequent recovery of our patient with severe acute asthma and respiratory failure may encourage others to try HFPV delivered through VDR…”

Effect of Intrapulmonary percussive ventilation on expiratory flow limitation in chronic obstructive pulmonary disease patients

Vargas F, Boyer A, Nam Bui H, Guenard H, Gruson D, Hilbert G. Effect of intrapulmonary percussive ventilation on expiratory flow limitation in chronic obstructive pulmonary disease patients. Journal of Crit Care. 2008. DOI:10.1016/j.jcrc.2008.02.006

“In COPD patients, a session of IPV allowed a significant reduction of EFL and of P01 and a significant improvement of gas exchange.”

Intrapulmonary Percussive Ventilation in Tracheostomized Patients: A Randomized Controlled Trial

Clini EM, Antoni FD, Vitacca M, et al. Intrapulmonary percussive ventilation in tracheostomized patients: a randomized controlled trial. Intensive Care Med. April 2006. http://dx.doi.org/10.1007/s00134-006-0427-8

“The addition of percussive ventilation to the usual chest physiotherapy regimen in tracheostomized patients improves gas exchange and expiratory muscle performance and reduces the incidence of pneumonia.”

IPV Safe for Mucus Clearance in Duchenne Muscular Dystrophy Patients

Toussaint M, De Win H, Steens M, Soudon P. Effect of Intrapulmonary Percussive Ventilation on Mucus Clearance in Duchenne Muscular Dystrophy Patients: A Preliminary Report. Respir Care. 2003; 48(10):940-947.

 The objective of the study was “to determine the effects of IPV on mucus clearance in tracheostomized Duchenne muscular dystrophy patients.” Eight patients were entered into a randomized crossover study.

For patients with hyper secretion within the standard deviation, weight of collected secretions was significantly higher than those without use of IPV.

“IPV is a safe airway clearance method for treacheostomized Duchenne muscular dystrophy patients, and this preliminary study suggests that IPV increases the effectiveness of assisted mucus clearance and techniques.”

Adult refractory hypoxemic acute respiratory distress syndrome treated with extracorporeal membrane oxygenation: the role of a regional referral center

Michaels A.J. MD, Hill J.G. MD, Long W.B. MD, Young B.P MD, Sperley B.P. DO, Shanks T.R. RN, et al.  Adult refractory hypoxemic acute respiratory distress syndrome treated with extracorporeal membrane oxygenation: the role of a regional referral center. The American Journal of Surgery. 2013. Retrieved from http://dx.doi.org/10.1016/j.amjsurg.2013.01.025

“ECMO provides support that prevents ventilator-induced lung injury while the lungs heal. The investigators present a series of 36 adults with refractory hypoxemic ARDS (ratio of partial pressure of oxygen to fraction of inspired oxygen <50) from 17 different facilities who, treated with ECMO at a single referral center, had a 60% survival rate.”

Comparison of intrapulmonary percussive ventilation and chest physiotherapy: a pilot study in patients with cystic fibrosis

Homnick DN, Natale JE, Pfeifle J. Comparison of intrapulmonary percussive ventilation and chest physiotherapy: a pilot study in patients with cystic fibrosis. American College of Chest Physicians. 1994; 105: 1789-93.

“Although none of these techniques have been shown to have a therapeutic benefit over conventional P&PD, they offer the advantage of increased patient independence, overcoming a significant barrier to compliance. The is especially true for adolescents and adults with CF.”

“Participants tolerated all respiratory treatment without adverse consequences. Subjectively, participants reported no discomfort with use of IPV compared with conventional P&PD Therapy.”

“In summary, a single IPV treatment was as effective as standard chest physiotherapy in improving acute pulmonary function and enhancing sputum expectoration in ambulatory older children and adults with excellent to moderate CF severity grades. Although this study was limited to the acute effects, it serves as an important starting point for long term studies of efficacy and safety of IPV use in patients with CF.”

Physiological response to intrapulmonary percussive ventilation in stable COPD patients

Nava S, Barbarito N, Piaggi G, De Mattia E, Cirio S. Physiological response to intrapulmonary percussive ventilation in stable COPD patients. Respiratory Medicine. 2006; 100, 1526-1533.

A randomized study of ten patients underwent IPV through a facemask at different pressure and frequency combinations.

The amount of “PEEPi,dyn was significantly reduced… suggesting a direct effect of IPV.” This study demonstrates that the use of IPV is associated with “a significant reduction of the diaphragm energy expenditure” The general conclusion of IPV use is that “it is safe, and overall well tolerated.”

Intrapulmonary percussive ventilation improves the outcome of patients with acute exacerbation of chronic obstructive pulmonary disease using a helmet

Antonaglia V, Lucangelo U, Zin WA, et al. Intrapulmonary percussive ventilation improves the outcome of patients with acute exacerbation of chronic obstructive pulmonary disease using a helmet. Crit Care Med. 2006; Vol. 34 No. 12

A randomized clinical trial in ICU at a university hospital of forty patients with exacerbated COPD were ventilated with a non-invasive positive pressure ventilation ‘helmet.’

“IPV treatment was feasible for all patients. Non-invasive positive-pressure ventilation by helmet associated with IPV reduces the duration of ventilator treatment and intensive care unit stay and improves gas exchange at discharge from intensive care unit in patients with sever exacerbation of COPD.”

High-frequency percussive ventilation in severe acute respiratory distress syndrome: A single center experience

Spapen H, Borremans M, Diltoer M, Van Gorp V, Nam Nguyen D, Honore P. High-frequency percussive ventilation in sever acute respiratory distress syndrom: A single center experience. J Anaesthesiol Clin Pharmacol. 2014 Jan-Mar; 30(1): 65-70. DOI:10.4103/0970-9185.125706

“HFPV caused rapid and sustained improvement in oxygenation and ventilation.”

Burn Center Treatment of Patients With Severe Anhydrous Ammonia Injury: Case Reports and Literature Review

White C.E. MD, Park M.S. MD, Renz E.M MD, Kim S.H. MD, Ritenour A.E. MD, Wolf S.E. MD, et al. Burn Center Treatment of Patients With Severe Anhydrous Ammonia Injury: Case Reports and Literature Review. American Burn Association. 2007.DOI: 10.1097/BCR.0b013e318159a44e

“Anhydrous ammonia (NH3) is a widespread industrial chemical, used in the fertilizer, refrigeration, petroleum, and explosive industries…. When exposed to water on the skin, in the eyes, or in the aero digestive tract, it forms ammonium hydroxide (NH4). This strong base is in turn responsible for the majority of the resultant damage. Because ammonia is a common cause of accidents involving toxic industrial chemicals, and because it could be used as a weapon of opportunity by terrorists or during armed conflict, familiarity with these injuries is important.”

“High frequency percussive ventilation using the VDR-4, which was also used in the care of these patients, is likely useful for clearing necrotic debris from the smaller airways.”

High-frequency Percussive Ventilation for Severe Inhalation Injury

Hiller K.N. MD, Morgan C.K. MD. High-frequency Percussive Ventilation for Severe Inhalation Injury. Anesthesiology. 2014:120(4).

A case study of a healthy 26 year old intubated after a house fire diagnosed with singed nares, carbonaceous tracheal secretions, and respiratory distress in addition to soot throughout the tracheobronchial tree consistent with severe inhalational injury. When conventional ventilation and medical practices resulted in worsened oxygenation and ventilation, HFPV was initiated.

“Because inhalation injury is predominantly a conducting and peripheral airway insult, HFPV may preferentially benefit these specific patients.”