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HIGH FREQUENCY CHEST WALL COMPRESSION

This is given by instrument consists of a vest linked to an air-pulse generator.although the sensation of the device is somewhat akin to mechanical percussion,it differs significantly in its mechanism of action.

HFCC works by differential airflow, that is , the expiratory flow rate is higher than the inspiratory flow rate, allowing the mucus to be transported from the periphery to the central airways for expectoration. HFCC has also been shown to decrease the viscosity of mucus, making it easier to mobilize.

Equipments required for HFCC:

The air-pulse generator, required for a treatment of HFCC, weighs just over 100 lbs, but can be wheeled from one room to another. The inflatable vest is constructed to fit over the entire thorax and should extend to the top of the thigh when the patient is sitting upright.

Five different sizes are available(from child to large adult). For use in a hospital setting, adjustable vests are available, which are fitted to subsequent patients with Velcro straps. Simultaneous use of an aerosolized medication or saline is recommended throughout the treatment. This humidifies the air to counteract the drying effect of the increased airflow.

Preparation for HFCC:

The patient should be seated upright in a chair. The vest should fit properly, but breathing should not feel restricted while the vest is deflated. A single layer of clothing should be worn under the vest. The pressure control setting should be adjusted to either the high or the low setting according to patient comfort. The foot hand control may be placed on the floor to be activated by stepping on it, or placed under the thigh to be activated by leaning on to it, or pressed with the hand.

Treatment with HFCC:

The treatment should progress through different frequencies, from low (7 to 10 Hz) to medium (10 to 15 Hz) and then to high (15 to 25 Hz), to achieve both higher flow rates and increased lung volume. Warwick (1991) reported that the frequencies associated with the highest flow rates were usually greater than 13 Hz, whereas those associated with the largest volume were usually less than 10 Hz.

The recommended protocol gives the option of intermittent or continuous use. For the Intermittent method, the patient should inhale deeply and depress the foot/hand control at peak inspiration. Exhalation should be passive and relaxed while the vest is pulsating. For the continuous method, the foot/hand control should be depressed while breathing normally. The average length of time spent at each frequency is 3 to 5 minutes, but this will vary according to patient tolerance, amount, and consistency of secretions, and the phase of the patients illness(acute or chronic).

Treatment

Treatment
After treatment at each frequency for the prescribed length of time, the foot/hand control should be released and the patient instructed to huff or cough to clear loosened secretions. The control is adjusted to the next prescribed frequency, and the procedure is repeated. HFCC has been used on a smaller scale with patients requiring long term mechanical ventilation.

Advantages of HFCC

This method of airway clearance allows independence and is easy to learn in a short period. HFCC is appropriate with those patients in whom PD positions are contraindicated, and it has been used successfully in reclining patients who are unable to tolerate the upright sitting position.
The amount of time for patient contact required for a hospital care giver is much less with this method than with conventional pd and percussion.

Use of HFCC may result in time savings at home as well as in a hospital or long term care facility. Nebulized medications are administered concurrently with the airway clearance treatment, and all lobes of the lungs are treated simultaneously. In those patients for whom it is appropriate (and reimbursable), HFCC is an effective method of airway clearance. It provides independence for long term use at home as well as for acute exacerbations in the hospital.

Disadvantages of HFCC

A disadvantage of this method of airway clearance is the cost of the equipment. A study of the impact of the device in a hospital setting (klous, 1993) showed a substantial lsavings as a result of therapy self administration. Its lack of portability, Although the device can be readily moved from room to room in the house, it does not accommodate use away from home.