Comparison of Intrapulmonary Percussive Ventilation and Chest Physiotherapy: Methods
The two most salient innovations provided by IPV-1 with respect to its application in CF therapy include (1) the simultaneous combination of mechanical with pharmacologic interventions (aerosols) to mobilize endobronchial secretions, and (2) the development of a patient-operated device for chest physiotherapy which may allow greater independence for the adolescent and adult with CF. To date, however, there are few published experimental studies in humans using this instrument, and none involving patients with CF.
We undertook a pilot study in nine patients with CF severity grades of excellent to moderate in order to begin to assess the effectiveness of IPV-1 in facilitating mucus production and mobilization as compared with standard aerosol and chest physiotherapy.
The study was approved by the Human Use Committee of Bronson Methodist Hospital. Buy ventolin inhaler fully Informed consent was obtained from all participants and the parents/guardians of those patients under 18 years old.
Participants with CF diagnosed by clinical history, physical examination, and standard pilocarpine ionotophoresis were recruited from the Cystic Fibrosis Center at Michigan State University/Kalamazoo Center for Medical Studies. Patients with a history of pneumothorax, pulmonary surgery, or with active acute respiratory infection were not eligible for the study. Severity of CF was determined for each participant prior to the start of the study using the Shwachman-Kulczycki table.
A randomized crossover trial consisting of three treatment regimens was administered to nine participants. On day 1 of the study, each participant was assigned to a sequence of three treatments that would be randomly received during a 5-day period. The three experimental treatment groups included the following: (1) IPV—2.5 mg albuterol in 19.5 ml normal saline solution delivered via the IPV-1 with simultaneous internal pulmonary percussion (oxygen delivery pressure 1.2 psi/kg body weight at a rate of 200 to 300 cycles per minute); (2) high volume aerosol and P&PD (HVA/P&PD)—2.5 mg albuterol in 19.5 ml normal saline solution delivered via the nebulizer component of the IPV-1 (with the internal percussive component inactivated), followed by respiratory therapist-administered external chest P& PD; and (3) standard aerosol and P&PD (STD)—2.5 mg albuterol in 3.0 ml normal saline solution delivered via standard nebulizer, followed by manual chest physiotherapy administered by a respiratory therapist according to CF Foundation guidelines.