Safety and efficacy of short-term intrapulmonary percussive ventilation in patients with bronchiectasis.


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Geplaatst door: Han Franssen op 2016-01-30 10:45:06

Respir Care. 2011 Jul;56(7):984-8. doi: 10.4187/respcare.01098. Epub 2011 Feb 21

Abstract
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 S(pO(2)), 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.

Nederlands:
Doelstelling: Om het effect en de veiligheid van IPV te vergelijken met reguliere thorax fysiotherapie
Setting: Twee centra. Gerandomized crossover studie. Tweeentwintig patiënten
Methode: tweeentwintig patiënten onder gingen afwisselend behandeling van IPV en thorax fysiotherapie– een dag IPV en de volgende dag thorax fysiotherapie gedurende dertig minuten. Vóór, direct na, dertig minuten en vier uur na iedere behandeling werd de SpO2, hart frequentie, ademhalings frequentie, dyspnoe/ benauwdhieds score ( door middel van de VAS score) en subjectieve gevoel van sputum productie gemeten.
Resultaten: Geen complicaties traden op bij beide behandelmethodes.
Bij IPV en thorax fysiotherapie daalde de hart frequentie en ademhalings frequentie. Beide behandelmethodes levert veel sputum productie op, maar er was geen verschil in het volume en gewicht van sputum. Enkel bij IPV nam het gevoel van benauwdheid af. De patient vonden de IPV behandelmethode meer comfortable dan de thorax fysiotherapie. 
Conclusie: Bij patiënten met bronchiectasis en een productieve hoest, IPV is een even veilig en effectief behandelmethode als thorax fysiotherapie. En IPV geeft minder ongemak