title: High-frequency chest wall oscillation in prolonged mechanical ventilation patients: a randomized controlled trial.
abstract: OBJECTIVE
  Patients with prolonged mechanical ventilation (PMV) often retain airway secretions, which may be cleared with the assistance of high-frequency chest wall oscillation (HFCWO). This study aimed to determine the effectiveness, safety and tolerance/comfort of HFCWO after extubation in PMV patients.
  
  
  METHODS
  This parallel-designed, randomized controlled trial enrolled subjects with both intra-tracheal intubation and mechanical ventilator support continuously for at least 21 days between January 2011 and December 2012. Upon extubation, the participants were randomly assigned to either receive HFCWO for 5 days or not. The effectiveness [based on weaning success rates, daily clearance volume of sputum, serial changes in sputum coloration and chest X-ray (CXR) improvement rates], safety (by physiologic parameters) and tolerance/comfort [using the Modified Borg Scale (MBS) and Hamilton Anxiety Scale (HAS)] of HFCWO were investigated.
  
  
  RESULTS
  There were 43 PMV subjects, including 23 in the HFCWO group and 20 in the non-HFCWO group. The weaning success rates were 82.6% (19/23) and 85% (17/20) in the HFCWO and non-HFCWO groups, respectively (P = 1.000). The HFCWO group had persistently greater numbers of daily sputum suctions and higher CXR improvement rates compared with the non-HFCWO group. There was significant sputum coloration lightening in the HFCWO group only. There was no significant difference in the MBS and HAS between the two groups and between pre- and post-HFCWO physiologic parameters.
  
  
  CONCLUSIONS
  In PMV patients, HFCWO was safe, comfortable and effective in facilitating airway hygiene after removal of endotracheal tubes, but had no positive impact on weaning success.
authors.affiliation: Division of Respiratory and Critical Care Medicine, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan.|Department of Medical Technology, Jen-Teh Junior College of Medicine, Nursing and Management, Miaoli, Taiwan.
authors.forename: Wei-Chang
authors.initials: WC
authors.lastname: Huang
authors.affiliation: Nursing Department, Taichung Veterans General Hospital, Taichung, Taiwan.
authors.forename: Pi-Chu
authors.initials: PC
authors.lastname: Wu
authors.affiliation: Nursing Department, Taichung Veterans General Hospital, Taichung, Taiwan.
authors.forename: Chao-Jung
authors.initials: CJ
authors.lastname: Chen
authors.affiliation: Division of Critical Care and Respiratory Therapy, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan.
authors.forename: Ya-Hua
authors.initials: YH
authors.lastname: Cheng
authors.affiliation: Nursing Department, Taichung Veterans General Hospital, Taichung, Taiwan.
authors.forename: Sou-Jen
authors.initials: SJ
authors.lastname: Shih
authors.affiliation: Division of Respiratory and Critical Care Medicine, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan.
authors.forename: Hui-Chen
authors.initials: HC
authors.lastname: Chen
authors.affiliation: Division of Critical Care and Respiratory Therapy, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan.|Department of Internal Medicine, Chiayi Branch, Taichung Veterans General Hospital, Chiayi, Taiwan.|Department of Respiratory Therapy, College of Health Care, China Medical University, Taichung, Taiwan.
authors.forename: Chieh-Liang
authors.initials: CL
authors.lastname: Wu
mesh_terms: D000368:Aged; D035641:Chest Wall Oscillation / Q000379:methods*; D005260:Female; D006801:Humans; D007442:Intubation, Intratracheal / Q000379:methods*; D008297:Male; D016896:Treatment Outcome; D015300:Ventilator Weaning / Q000379:methods
keywords: effectiveness; elderly; high-frequency chest wall oscillation; mechanical ventilation; pneumonia; randomized controlled trial