High Frequency Chest Wall Oscillations (HFCWO ...

Jagtar Singh OBE - Chair Simon Gilby - Chief Executive

Coventry & Warwickshire Partnership NHS Trust Wayside House, Wilsons Lane, Coventry, CV6 6NY

Tel: 024 7636 2100 Fax: 024 7636 8949 www.covwarkpt.nhs.uk

HighFrequencyChestWallOscillations(HFCWO)&MechanicalInsufflation–Exsufflation(MI-E)Pathway

ThisdocumentrecommendscriteriatobeusedacrossCoventryandWarwickshirewhenrequestingfundingforhighfrequencychestwalloscillations(HFCWO)andmechanicalinsufflation-exsufflation(MI-E)forindividualpatientsalongsidetheavailableevidencebase.Thesedevicesareprovidedasstandardtreatmentinsomeareasforindividualswithneuromusculardisease(NMD)basedonrecommendedstandardsofcare(20,22,27,29).

HFCWOandMI-Earetypesofairwayclearancetechniquesusedbyrespiratoryphysiotherapiststoenhanceclearanceofexcessbronchialsecretions,totryandminimiseinfectionandthereforepreventrepeatedlungdamage.Thechild/youngperson(CYP)specificuseofthesetreatmenttechniquescanbetaughtbyarespiratoryphysiotherapist,tonurses,supportworkers,carersandfamiliesusingarespiratoryphysiotherapytreatmentplanaspartofacompetencytrainingpackage.

IfahealthcareprofessionalfeelstheHFCWO/MI-EmaybebeneficialfortheCYP,theymustdiscusswithmultidisciplinaryteam(MDT)includingtherespiratoryphysiotherapist.Arespiratoryassessmentmustbecarriedoutbyarespiratoryphysiotherapist.Ifacommunityrespiratoryphysiotherapistisnotavailable,fundingforaformalassessmentbyarespiratoryphysiotherapistmustbeagreedbyCCG.Devicecostsaredetailedinappendix1.

Device

CostofEquipment(excluding

VAT)

1yearsupplyconsumables Rentalcosts Warranty TrialLoan

period

NippyClearwayBreasMedical(MI-Edevice)

£3300.00 £160.00

£190.00permonth,minimumrental12

weeks

1year 2months

E70CoughAssistPhilips

(MI-Edevice)

£3,436.51-£3,702.91

£33.28

£380.00permonth

1year 1month

TheVestHill-Rom

(HFCWOdevice)

£6,995.00 Noinitialcost

£10.00perday

minimumrental3month

2year 3months




1. InitialassessmentforHFCWO/MI-ETheCYPshouldbeassessedbyarespiratoryphysiotherapist(acuteorcommunity).ThechoiceofairwayclearancetechniqueisdecidedbytherespiratoryphysiotherapistandtheCYP/CYP’sfamily.Beforestarting,theremustbeclearindicationsandevidenceofotherairwayclearancetechniquesthathavebeentriedandhavenotbeeneffective.

CriteriaforHFCWO:TheHFCWOisusedtofacilitateairwayclearanceofsecretionsinCYPswhohaveacuteandchronicrespiratoryconditions.TheHFCWOrapidlyinflatesanddeflatesthevestcompressingandreleasingthechestwallcausinghighfrequencyoscillationswhichreplicatemini-coughs.Theseminicoughs,dislodgethemucusfromthewalloftheairwaysandwiththeincreasedstrengthoftheciliarybeatthroughresonance,helpstransportittothelargercentralairwaysforclearance.HFCWOmaybeconsidered:

• Acutechestinfectionwithsecretionretention• Chronicmucushypersecretionorsecretionretentionassociatedwithachronicpulmonary

orneuromuscularcondition• Alternativeairwayclearancetherapyprovenineffectiveorcontraindicatede.g.persistent

atelectasisdespitenormalairwayclearance• Longtermventilatedwithevidenceofsecretionretention• OngoingfatiguedespitetheinitiationofNIV,lackofstrengthorabilitytoperformactive

respiratoryphysiotherapytreatmente.g.activecycleofbreathing� Symptomatice.g.dailysecretionretention,recurrentrespiratoryinfections,SpO2<95%due

tosecretionretention,frequenthospitalisationse.g.threeormoreperannum,HDUandPICUadmissions,declineinlungfunction,regularantibiotics/steroidsrequiredforchestinfections

� Prolongedabsencefromschoolduetochestinfections.� Highburdenofcaree.g.siblingswithadditionalhealthcareneeds,otherdependants/

commitments,carerdisability,significantdependenceonchestphysiotherapyneed,relianceonotherstoassistwithmucusclearanceandphysicaldemandonpatientandcarerstoperformtreatment.

(1-17,36).

Appendix2haschartstoshowthecriteriaindicatedandtotalnumberofcriteriaforusingHFCWOinCYPinCoventryandWarwickshirePartnershipTrust(CWPT)andotherareasbetweenMarch2017andMay2018.InCWPT,thereare3CYPwhorequiredHFCWOandthetotalnumberofcriteriaindicatedwasbetween5and8.DatawasalsocollectedontheuseofHFCWOfromotherphysiotherapistsacrosstheUKworkingintheacutesectorandcommunity.Thetotalnumberofcriteriaindicatedfromotherareaswasbetween3and8.DuringthisdatacollectionitbecameevidentthatHFCWOisnotwidelyusedbytheothertrusts,andsoitwasdecidedtoonlyusethedatafromCWPTas3CYPareusingtheHFCWO.ItisthereforerecommendedthatifaCYPinCWPTmeets5ormoreofthecriteria,HFCWOmaybeconsidered.ThisisonlyaguideandclinicalreasoningshouldbeappliedwhenselectingappropriateairwayclearancedevicesfortheCYP.




CriteriaforMI-E:IneffectivecoughisamajorcauseofmortalityandmorbidityinCYPwithNMD.Thisleadstorecurrentpulmonaryinfectionwhichcausesprogressivelungdamageandpoorrespiratoryfunction;andeventuallyrespiratoryfailure.MI-EisusedasadevicetoaidCYPtoclearretainedbroncho-pulmonarysecretions.MI-EisalsousedwithCYPwhohavedecreasedinspiratoryeffort,duetoeitherspinalcordinjuryorNMD;andwhohaveanimpairedorineffectivecoughwithappropriaterespiratorysymptoms.MI-Eisconsideredwhenconventionalcoughassistancetechniques(e.g.breathstacking,manualassistedcough)becomeineffective.MI-Einflatesthelungswithgradualpositiveairwaypressurefollowedbyarapidswitchtonegativeairwaypressure.Thissimulatestheflowchangesthatoccurduringacough,andassistsclearanceofsecretions.MI-Emaybeconsidered:

• Acutechestinfectione.g.chestexacerbation,increaseinsputum• Chronicmucushypersecretionorsecretionretentionassociatedwithaneuromuscular

condition• Ineffectivecoughorinabilitytoremovemucusbycoughing.Indicationsforstartingcough

assistancetechniquesforCYPwithneuromuscularweakness:o InCYP,whoareabletoperformareproducibleforcedexpiratoryflowmanoeuvre,a

forcedvitalcapacity<50%ofpredictedisanindicationforMIE.o Inadultswithneuromuscularweakness,aPCF(peakcoughflow)>160litres/minis

necessaryforeffectivesecretionclearanceandaPCF>270litres/minisassociatedwithresiliencetorespiratoryinfection.TheminimumPCFacceptedasnormalis400litres/minandisreachedbetween12-13yrs.Thereforeindicated:

§ Inchildren>12yrswhohaveaPCF<270litres/min,particularlyiftheyhavehadepisodesofdeteriorationwithrespiratoryinfection.

§ Inchildren>12yrs,PCF<160litres/minisastrongpredictorofseverechestinfections,respiratoryfailureandindicatethatCYPshouldstartassistedcoughingmethods,evenintheabsenceofrespiratorycomplicationsinthemedicalhistory

• Wherebreathstackingand/ormanualassistedcoughprovenineffectiveorcontraindicatede.g.osteopenia,persistentatelectasisdespitenormalairwayclearance

• Longtermventilatedwithevidenceofsecretionretention• Clinicalevidenceofhyperinflationand/orairtrapping� OngoingfatiguedespitetheinitiationofNIV,lackofstrengthorabilitytoperformactive

respiratoryphysiotherapytreatment.� Symptomatice.g.dailysecretionretention,recurrentrespiratoryinfections,SpO2<95%due

tosecretionretention,frequenthospitalisationse.g.threeormoreperannum,HDUandPICUadmissions,declineinlungfunction,regularantibiotics/steroidsrequiredforchestinfections

� Prolongedabsencefromschoolduetochestinfections.




• Highburdenofcaree.g.siblingswithadditionalhealthcareneeds,otherdependants/commitments,carerdisability,significantdependenceonchestphysiotherapyneed,relianceonotherstoassist(18-36).

Appendix2haschartstoshowthecriteriaindicatedandtotalnumberofcriteriaforusingMIEinCYPinCWPTandotherareasbetweenMarch2017andMay2018.InCWPT,thereare4CYPwhorequiredMI-Eandthetotalnumberofcriteriaindicatedwasbetween6and9.Thetotalnumberofcriteriafromotherareasvariedbetween3to9.MI-Eisamorecommonlyuseddeviceanddatashowedacrosstheareasonaverage,theminimumnumberofcriteriaindicatedforusingMI-Ewas5ormore.ItisthereforerecommendedthatifaCYPinCWPTmeets5ormoreofthecriteria,MI-Emaybeconsidered.ThisisonlyaguideandclinicalreasoningshouldbeappliedwhenselectingappropriateairwayclearancedevicesfortheCYP.2. TrialPeriodTheHFCWO/MIEshouldonlybesetupandmodifiedbyatrainedrespiratoryphysiotherapist.TheRespiratoryPhysiotherapist’srolewillinclude:

• GainingagreementfromtheLeadconsultant–community/acute.ThereneedstobeanagreementthatthisleveloftreatmentisappropriateforlongtermusefortheCYPconsideringfactorssuchaspalliationbeforebeingdiscussedwithCYPandfamily.

• GainingconsentandcommunicationwithCYPandfamily• InformingCommunityChildren’sNurse(CCN)andcontinuingcaregroup/healthpanel.• Ifdevicestartedbyrespiratoryphysiotherapistintertiarycentre,needtoliaisewith

communityrespiratoryphysiotherapist.Ifcommunityrespiratoryphysiotherapistserviceunavailable,needtoconsiderhowtheCYPanddevicewillbemonitoredinthecommunity.

• Ifrecommendationispartofanewcontinuingcaresassessment,therespiratoryphysiowillprovidetheinformationtotheCCNtoincludeintheCYPassessment.

• InformotherhealthcareprofessionalsinvolvedinCYPcareasappropriate.• ArrangeloanequipmentfromHill-Rom,Philips,Nippybycompletingloanrequestformif

appropriate.• Providechildspecificrespiratoryphysiotherapytreatmentplantoincludebackup

treatmentifHFCWO/MI-Ebreaks.Tobewrittenbyrespiratoryphysiotherapist.• Arrangetrainingandcompletechildspecificcompetenciesforcarers/familymembersby

respiratoryphysiotherapist.• ConsiderwhereHFCWO/MI-Ewillbesetupandused:home/School/nursery/hospital/

hospice.• RespiratoryPhysiotherapisttodelivertrainingandcompletechildspecificcompetenciesfor

carers/familymembers• ProvideCYPfamilywithcontactnumbersforrespiratoryphysioandwhotocontactfor

consumablesifrequired.• Ifrentingdevice,additionalconsumableswillneedtobeaddedtorentalcosts.• Provideequipmentmanual&cleaninginstructionsplan.




Outcomemeasures:Duringtheassessmentatthebeginningofthetrialbytherespiratoryphysiotherapist,appropriateoutcomemeasureswillbedefinedtogetthebestobjectivefeedbackontheeffectivenessofthetreatmentduringthetrialperiod.Appropriatemembersofthefamilyorcareteamwillbeaskedtorecordtheseobjectivemeasurestoenabletherespiratoryphysiotherapisttoassesstheresultsofthetrial.Thefollowingisanexampleofsomeobjectivemeasuresthatmightbeused:

ShortTermmeasures• Observationofrespiratorypattern&rate• Auscultation• Oxygensaturations• Cough• Peakcoughflow• Sputum• Ventilatorsettings• Oxygenrequirement• Numberofsuctions/cathetersused

LongTermmeasures• Lungfunctiontest(astheygetolderandifable)• Chestx-rayifable• ComplianceandCYPperspective• Lengthoftreatment• Exercisetolerance• Microbiology• Numberofhospitaladmissions• Numberofrespiratoryinfections• Numberofcoursesofantibioticsforrespiratoryinfection• Easeofteaching/learning• Burdenofcare• Numberofcarersrequiredtoperformtreatment• Costs(directandindirecttobeevaluatedpriortostartingdevicee.g.lengthofhospitalstay

withassociatedward,HDUorPICUbedcosts,antibioticcoursesandcosts.

3. TrialSuccessfulTherespiratoryPhysiotherapisttoinform:

• CCNandcontinuingcaregroup/healthpanel.• Companyandrequestaformalquoteincludingconsumablesforayearandservicing/

warranty.• OncefundingagreedbyCCG,informhealthcareprofessionalsinvolvedasappropriate.

Oncepurchased,HFCWO/MI-EtohaveassetnumberandPATtestedasrequiredbytrustpolicy.Ongoingmonitoring,trainingoffamily/carers,CYPassessmentandcompetencyyearlyreviewbyacuteorcommunityrespiratoryphysiotherapist.Annualserviceandmaintenanceofequipmentaspermanufacturer’sguidance.Ensureprovisionofconsumables




AuthorAnnikaShepherd,ClinicalLeadRespiratoryPhysiotherapistCYPComplexPhysicalHealthServicesChildandFamilyServices,CWPTDate:October2018Specialthankstofollowingprofessionalsforcommentsandinformation:EmilyParry,CommunityChildren’sNurse,SouthWarwickshireNHSFoundationTrustDonnaPowell,LeadnurseforChildren’sContinuingCare,SouthWarwickshireNHSFoundationTrustLouiseBridges,ServiceManager,CYPComplexPhysicalHealthServicesChildandFamilyServices,CWPTAssociationofPaediatricChartedPhysiotherapist(APCP)respiratorycommittee:LaurenWilliams,AdvancedPhysiotherapist,SheffieldChildren’sHospitalSheonaStubbs,TeamLeadPaediatricPhysiotherapist,SerennuChildren'sCentre,NewportJoThornton,SpecialistPaediatricPhysiotherapist,BurnleyHospitalRachelEvans,IndependentPaediatricRespiratoryPhysiotherapistZoeJohnstone,ClinicalSpecialistRespiratoryPhysiotherapist,RHSCEdinburghAlliedHealthprofessionalsMidlandsLongTermVentilationNetwork:NickyMcNarry,RegionalLTVClinicalSpecialistPhysiotherapist,NottinghamChildren’sHospitalNicRutter,ContinuingCareTeamSpecialistPhysiotherapist,DerbyChildren’sHospitalDrMichelleChatwin,ConsultantPhysiotherapist,RoyalBromptonHospital.




HFCWOReferences

1. AnbarRD(1998)CompliancewithuseofThAIRapyVestbypatientswithcysticfibrosis,PaediatricPulmonol1998(suppl17):346,A497

2. AnbarRD.(1999)UseofThAIRapy®Vestdoesnotaffectliverfunctionofpatientswithcysticfibrosis.AmJRespirCritCareMed;159(3),A687.

3. Appetal(1998)PhysiotherapyandmechanicalbreakdownoftheexcessiveDNAloadinCFsputum-ananti-inflammatorytherapeuticstrategy,PaediatricPulmonology,suppl17;349,A507.

4. ButlerS,O’NeillB(1995)Highfrequencychestcompressiontherapy:acasestudy.PediatrPulmonol;19:56-59.

5. Burnettetal(1993)Comparativeefficacyofmanualchestphysiotherapyandahighfrequencychestcompressionvestininpatienttreatmentofcysticfibrosis,AmRevRespirDis1993;(suppl147):A30

6. CastagninoM,VojtovaJ,KaminskiS,FinkR(1996)SafetyofHighFrequencyChestWallOscillationinpatientswithrespiratorymuscleweakness.Chest;110:S65.

7. ChiappettaA,BeckermanR(1995).HighFrequencyChestWallOscillationinspinalmuscularatrophy(SMA).RTJRespirCarePract;8(4):112-114.

8. GomezA,ElisanI,HardyK(2000)HighFrequencyChestWallOscillation:videodocumentationofeffectonapatientwithduchenne’smusculardystrophyandseverescoliosis.Posterpresentationatthe46thInternationalRespiratoryCongressoftheAmericanAssociationforRespiratoryCare,October7,Cincinnati,Ohio,USA.

9. Hansenetal(1990)Highfrequencychestcompressionsystemtoaidinclearanceofmucusfromthelung.BiomedInstrumTechnolo,24,pp289-294

10. Kluftetal(1996)AcomparisonofbronchialdrainagetreatmentsinCF,PaediatricPulmonol,Oct1996,22(4),p271-4

11. Ndukwuetal(1999)ComparisonofHFCWOandmanualchesttherapyinlongtermacutecarehospitalventilator-dependantpatients,Chest,116

12. OermannCMetal(2001)ComparisonofHFCWOandoscillatingPEPinhomemanagementofCF:apilotstudy,PaediatricPulmonolv32,no.5,Nov,p372-377

13. PiquetJ,BrochardL,IsabeyD,DeCremouxH,ChangHK,BignonJ,HarfA.(1987)Highfrequencychestwalloscillationinpatientswithchronicairwayobstruction,AmRevRespiratorydisease,136,pp1355-1359

14. PerryRJ,ManGCW,JonesRL(1998)Effectsofpositiveend-expiratorypressureonoscillatedflowrateduringhighfrequencychestcompression.Chest;113(4):1028-1033.

15. Robinsonetal(1992)Evaluationofahighfrequencychestcompressiondeviceincysticfibrosis,PaediatricPulmonol1992;(suppl8):304,A225

16. Whitmanetal(1993)Preliminaryevaluationofhighfrequencychestcompressionforsecretionclearanceinmechanicallyventilatedpatients.RespiratoryCare,38(10),pp1081-108

17. NICE:TheVestfordeliveringhigh-frequencychestwalloscillationinpeoplewithcomplexneurologicalneeds:Medtechinnovationbriefing(2018)




MI-EReferences

18. Andersonetal.Systematicreviewoftechniquestoenhancepeakcoughflowandmaintainvitalcapacityinneuromusculardisease:thecaseformechanicalinsufflation-exsufflation.PhysicalTherapyReview2005;10:25-35

19. BachJR.Amyotrophiclateralsclerosis:prolongationoflifebynoninvasiverespiratoryAIDS.Chest.2002;122(1)92-8

20. Birnkrant(2018)DiagnosisandmanagementofDuchennemusculardystrophy,part2:respiratory,cardiac,bonehealth,andorthopaedicmanagement.LancetNeurology,vol17

21. BritishThoracicSocietyGuidelineforrespiratorymanagementofchildrenwithneuromuscularweakness;JeremyHull,RoonaAniapravan,ElaineChan,MichelleChatwin,JulianForton,JayneGallagher,NeilGibson,JillGordon,ImeldaHughes,ReneeMcCulloch,RobertRossRussell,AnitaSimonds,Thorax;July2012,vol27

22. BritishThoracicSociety/ACPRCguidelines;Physiotherapymanagementoftheadult,medicalspontaneouslybreathingpatientMay2009

23. ConsensusStatementonStandardofCareforCongenitalMuscularDystrophies(2010)JournalofChildNeurology25(12)1559-1581

24. CWPT:Community–ChildrenandYoungPeople:ClearwayMechanicalInsufflation-ExsufflationClinicalProcedure

25. Fauroux B, GuillemotN, AubertonG,NathanN, Labit A, Clement A, et al. Physiologic benefits ofmechanical insufflation-exsufflation in childrenwithneuromusculardiseases.Chest.2008;133(1):161-8.

26. Finkeletal(2018)Diagnosisandmanagementofspinalmuscularatrophy:Part2:Pulmonaryandacutecare;medications,supplementsandimmunizations;otherorgansystems;andethics.NeuromuscularDisorders28,197–207

27. GuerinC:BourdinG:LerayV;DelannoyB;BayleF;GermainM;RichardJC(2011)performanceofthecoughassistinsufflations-exsufflationdeviceinthepreseanceofanendotrachealtubeoftrachesotomytube:abenchstudy.RespiratoryCare;August;vol56,vol56,no.8.

28. Kravitz,R.(2009).AirwayclearanceinDuchenneMuscularDystrophy.Pediatrics,123(Suppl4)29. NHSEngland'sservicespecificationforneurosciences:specialisedneurology(adult)D04/S/a-Annex

Bincludeschildren201330. RespiratoryCareofthePatientwithDuchenneMuscularDystrophy:ATSconsensusStatement.AmJ

RespirCritCareMed.2004August15,2004:170(4)456-6531. ToussaintM(2011).Theusemechanicalinsufflations-exsufflationviaartificialairways.Respiratory

Care;August;vol56,No6.pp1217-9.32. Wang,Cetal(2007)ConsensusStatementforStandardofCareinSpinalMuscularAtrophy,Journal

ofChildNeurology,Volume22Number8,August20071027-104933. Winck,JC,Goncalves,MR,Lourenco,C,etalEffectsofmechanicalinsufflation-exsufflationon

respiratoryparametersforpatientswithchronicairwaysecretionencumbrance.Chest2004;126,774-780

34. Winck,JC,Goncalves,MR.Commentary:Exploringthepotentialofmechanicalinsufflation–exsufflationBreathe,June2008,Vol4,No4

35. Winfield,N.(2014).Non-pharmaceuticalmanagementofrespiratorymorbidityinchildrenwithsevereglobaldevelopmentaldelay.TheCochraneDatabaseofSystematicReviews

36. Chatwin,Metal(2018)Airwayclearancetechniquesinneuromusculardisorders:Astateoftheartreview,RespiratoryMedicine136,98-100




Appendix(1)

Quotes(March2018)NippyClearwayBreasMedical(MI-Edevice):(excludingVAT)

• Costofequipment:£3300.00withstarterpack.• 1Yearsupplyofconsumables:Mask,Tubeandfilterboxof12for1year£160.00.Replace

monthly.Thismayvarydependingonlocalinfectioncontrolpolicy.• Rentalcosts:£190.00permonthincludesdeviceandconsumables.Minimum12weeks

rental.Nodailyrentaloption• Warranty:1year• Servicingoptions:Differentoptions.Bronzeservice(annualServicewithnoloandevice)

£150.00,Silver£500.00andGold£780.00.Maybeabletobeservicedlocally.• TrialLoanperiod:2monthsnocharge

E70CoughAssistPhilips(MI-Edevice):(excludingVAT)

• Costofequipment:£3,436.51or£3,702.91withbattery,circuitsx12andfilters• 1Yearsupplyofconsumables:circuit,interfaceandfilterperpack£16.64sox2£33.28per

year.Replace6monthly.Thismayvarydependingonlocalinfectioncontrolpolicy.• Rentalcosts:£380.00permonth• Warranty:1year• Servicingoptions:Differentoptions.Bronzeservice£255.00,Silver£340.00andGold

£298.00for1styear.Maybeabletobeservicedlocally.• TrialLoanperiod:1monthnocharge

TheVestHill-Rom(HFCWOdevice):(excludingVAT)

• Costofequipment:£6,995forunit(airpulsegenerator),hoses,twopermanentgarments,remote,manualandbluebag.

• 1Yearsupplyofconsumables:Permanentgarments(£275-295.00each)andhoses(£25.00set)shouldlast2-3years.

• Rentalcosts:£10.00perdaywithminimumrental3monthperiod• Warranty:2years• Servicingoptions:Fixedpricerepair£399.00.Differentoptionsfrom£245.00to£358.00

excludingVAT.Maybeabletobeservicedlocally.• TrialLoanperiod:3monthnocharge

FundingacrossUKTherearelargevariationsinhowequipmentisfundedacrossservicesinEngland,ScotlandandWales.ThismaydependonlocalCCGagreements.

• InScotlandandWales,donotapplyforfundingforequipmentsuchasventilatorsandcoughassist.Maybeprovidedbytertiarycentre.

• UHNMhaveaCCGfundingagreementforcoughassists




Appendix2

AcharttoshowthecriteriaindicatedforusingHFCWOinCYPinCWPTandotherareasbetween

March2017andMay2018.

Atotalof6CYPwereusedinthissurvey.ThechartshowsthecriteriaindicatedforusingHFCWOineveryCYPwere:

• Chronicmucushypersecretionorsecretionretentionassociatedwithachronicpulmonaryorneuromuscularcondition

• OngoingfatiguedespitetheinitiationofNIV,lackofstrengthorabilitytoperformactiverespiratoryphysiotherapytreatment

• Highburdenofcare

0

1

2

3

4

5

6

7

Acutechestinfectio

nwith

secretion

retention

Chronicmucushypersecretionorse

cretion

retentionassociated

with

achron

ic

pulm

onaryorneu

romuscularcon

ditio

n

Alternativeairw

ayclearanceth

erapy

proven

ineffectiveorcon

traind

icated

Longte

rmven

tilated

with

evide

nceof

secretionretention

Ongoingfatig

uedespiteth

einitiationof

NIV,lackofstrengthora

bilitytoperform

activ

erespira

toryphysio

therapytreatm

ent

Symptom

atic

Prolon

gedabsencefrom

scho

oldue

to

chestinfectio

ns

Highburde

nofcare

NoofCYP




AcharttoshowthetotalnumberofcriteriaindicatedforusingHFCWOinCYPinCWPTandotherareasbetweenMarch2017andMay2018.

EachcolumnrepresentsoneCYPinanarea.InCWPT,thereare3CYPwhorequiredHFCWOandthetotalnumberofcriteriaindicatedwasbetween5and8.ThedatawascollectedfromotherphysiotherapistsacrosstheUKworkinginacuteandcommunitysectors.Thetotalnumberofcriteriaindicatedfromotherareaswasbetween3and8.HFCWOisnotwidelyusedandsoitwasdecidedtousethedatafromCWPTas3CYPareusingtheHFCWO.IfaCYPinCWPTmeets5ormoreofthecriteria,HFCWOmaybeconsidered.ThisisonlyaguideandclinicalreasoningshouldbeappliedwhenselectingappropriateairwayclearancedevicesfortheCYP.

0

1

2

3

4

5

6

7

8

9

NUH CWPT CWPT CWPT RHSC Sheffield

Noofcriteria




AcharttoshowthecriteriaindicatedforusingMIEinCYPinCWPTandotherareasbetweenMarch2017andMay2018.

Atotalof65CYPwereusedinthissurvey.ThechartshowsthecriteriaindicatedineveryCYPforusingtheMIEwas:

• IneffectivecoughorinabilitytoremovemucusbycoughingThenextmostcommoncriteriaindicatedforusingtheMIEwere:

• OngoingfatiguedespitetheinitiationofNIV,lackofstrengthorabilitytoperformactiverespiratoryphysiotherapytreatment

• Wherebreathstackingand/ormanualassistedcoughprovenineffectiveorcontraindicated• Highburdenofcare

0

10

20

30

40

50

60

70

Acutechestinfectio

nwith

secretion

retention

Chronicmucushypersecretionor

secretionretentionassociated

with

a

chronicpu

lmon

aryorneu

romuscular

cond

ition

Ineffectivecoughorinabilityto

remove

mucusbycoughing

Whe

rebreathstackingand

/orm

anual

assistedcoughproven

ineffectiveor

contraindicated

Longte

rmven

tilated

with

evide

nceof

secretionretention

Clinicalevide

nceofhyperinfla

tionand/

orairtrapping

Ongoingfatig

uedespiteth

einitiationof

NIV,lackofstrengthora

bilityto

performactiverespira

tory

physiotherapytreatm

ent

Symptom

atic

Prolon

gedabsencefrom

scho

oldue

to

chestinfectio

ns

Highburde

nofcare

NoofCYP




AcharttoshowthetotalnumberofcriteriaindicatedforMIEinCYPinCWPTandotherareas

betweenMarch2017andMay2018.

InCWPT,thereare4CYPwhorequiredMI-Eandthetotalnumberofcriteriaindicatedwasbetween6and9.Thetotalnumberofcriteriafromotherareasvariedbetween3to9.MI-Eisamorecommonlyuseddeviceanddatashowedacrosstheareasonaverage,theminimumnumberofcriteriaindicatedforusingMI-Ewas5ormore.IfaCYPinCWPTmeets5ormoreofthecriteria,MI-Emaybeconsidered.ThisisonlyaguideandclinicalreasoningshouldbeappliedwhenselectingappropriateairwayclearancedevicesfortheCYP.NB:Sheffieldcriteria:TheonepatientwithsignificantlylowercriteriahadAtaxia-telangiectasia(AT)andadvisedtoprovideMI-EfromspecialistcentreduetoareducedPCFresult(asidentifiedinstandardsandseecriteriaabove).

0

1

2

3

4

5

6

7

8

9

10

NUH

NUH

NUH

NUH

NUH

NUH

NUH

NUH

NUH

NUH

NUH

NUH

NUH

NUH

CWPT

CWPT

Private

HH

HH

HH

HH

RHSC

RHSC

Sheffie

ld

Sheffie

ld

Sheffie

ld

Sheffie

ld

Sheffie

ld

Sheffie

ld

Noofcriteria

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