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Physiologic Evidence for High-Frequency Chest Wall Oscillation and Positive Expiratory Pressure Breathing in Hospitalized Subjects With Cystic Fibrosis

JC Darbee, PT, PhD, is Assistant Professor, Department of Rehabilitation Sciences, Division of Physical Therapy, College of Health Sciences, University of Kentucky, 900 S Limestone St, Lexington, KY 40536 (USA) (darbee{at}uky.edu)
JF Kanga, MD, is Professor of Pediatrics and Chief, Division of Pediatric Pulmonology, Department of Pediatrics, School of Medicine, University of Kentucky
PJ Ohtake, PT, PhD, is Associate Professor, Department of Rehabilitation Sciences, University at Buffalo, The State University of New York, Buffalo, NY. Dr Ohtake is supported by grants from the American Lung Association and the Interdisciplinary Research and Creative Activities Fund–University at Buffalo (IRCAF)

Address all correspondence to Dr Darbee

Background and Purpose. This investigation identified ventilation distribution, gas mixing, lung function, and arterial blood oxyhemoglobin saturation (Spo₂) physiologic responses to 2 independent airway clearance treatments, high-frequency chest wall oscillation (HFCWO) and low positive expiratory pressure (PEP) breathing, for subjects who had cystic fibrosis (CF) and who were hospitalized during acute and subacute phases of a pulmonary exacerbation. Subjects. Fifteen subjects with moderate to severe CF were included in this study. Methods. Subjects performed single-breath inert gas tests and spirometry before and immediately after HFCWO and PEP breathing at admission and discharge. Arterial blood oxyhemoglobin saturation was monitored throughout each treatment. Results. At admission and discharge, PEP breathing increased Spo₂ during treatment, whereas HFCWO decreased Spo₂ during treatment. Ventilation distribution, gas mixing, and lung function improved after HFCWO or PEP breathing. Discussion and Conclusion. High-frequency chest wall oscillation and PEP breathing are similarly efficacious in improving ventilation distribution, gas mixing, and pulmonary function in hospitalized people with CF. Because Spo₂ decreases during HFCWO, people who have moderate to severe CF and who use HFCWO should have Spo₂ monitored during an acute exacerbation.

Key Words: Airway clearance • Chest physical therapy • Cystic fibrosis • Gas mixing • Ventilation distribution

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