1. Effect on Expiratory Flow
Normal
Flutter
Acapella
Aerobika
Fink et al. Resp Care 2002:47:7;

2. High Frequency Assisted Airway Techniques
High Frequency Chest Wall Oscillation
High Frequency Chest Wall Compression
Intrapulmonary Percussive Ventilation

3. High Frequency Chest Wall Oscillation (HFCWO)
Achieved with rigid chest cuirass delivering pos. & neg. pressure breaths.
Hayek Oscillator System
I:E=1:6 to 6:1 ratio
cm H2O
Specialized “Secretion Mode”

4. Fink et al. Resp Care 2002:47:7;797-807
Flow, Airway Pressure, & Esophageal Pressure Waveforms HFCWO (Hayek Oscillator System)
Fink et al. Resp Care 2002:47:7;

5. High Frequency Chest Wall Compression (HFCWC)
Hil-Rom Vest
Uses inflatable Vest.
Actively compresses chest wall (5-20 cm H2O).
Generates short bursts of expiratory flow
Deflation is passively recoiled forcing expiratory flow
inCourage
Smart Vest

6. Fink et al. Resp Care 2002:47:7;797-807
Flow, Airway Pressure, & Esophageal Pressure Waveforms HFCWC- (Vest Therapies)
Fink et al. Resp Care 2002:47:7;

7. Intrapulmonary Percussive Therapy
Intrapulmonay Percussive Ventilation (IPV)
1985 Dr. Forest Bird
mini-bursts
MetaNeb (Hil-Rom)
3 in 1 system
CPEP Therapy
Aerosol Therapy
High Frequency Percussive Therapy.

8. Used in a variety of settings

9. Fink et al. Resp Care 2002:47:7;797-807
Flow, Airway Pressure, & Esophageal Pressure Waveforms Intrapulmonary Percussion
Fink et al. Resp Care 2002:47:7;

10. Mechanism of Action for High Frequency Devices
OCI= Oscillatory Clearance Index
f= Oscillatory frequency (Hz)
TI=duration of outward inspiratory airway wall displacement
TE=duration of inward expiratiory airway wall displacement
VE-max= Maximum exp. Flow
VI-max= Max insp. flow
Mechanism whereby an intrapulmonary percussive device
creates small flow pulses and expands secretion-obstructed airways
(A). Pressure accumulates behind the blocked areas and
moves mucus toward the larger airways (B) to be coughed out. 10

11. A closer look at how mucus is thought to be dislodged……..1
Insp 2 3
Exp 4