Green flutter valve7/22/2023 By contrast, six of the 10 patients achieved a CWI of 0 with the Flutter valve only one patient was able to score a CWI of 2 with the Flutter valve.ĭATA SUGGEST if patients are unable to maintain peak expiratory flows of > 200 L/min for extended times, the Flutter valve is ineffective. ![]() This means the entire patient thorax was shaking like a bowl of Jello. Our study clearly showed we were able to achieve the maximum CWI score of 2 in nine of the 10 patients with IPV therapy. Logically, with Flutter or IPV, the oscillations begin from inside the airway lumens and emanate toward the periphery and finally are observed or felt on the external chest wall.Ĭonversely, traditional CPT begins with oscillations/percussions on the extrathoracic chest wall and caregivers hope vibrations reach the lung periphery. We assumed one of the best clinical indicators for assessing the effectiveness of the two devices would be to evaluate the external thorax oscillations during therapy. Under the scoring system, a CWI of 0 denoted no visible or tactile thorax oscillations a CWI score of 1 showed upper bilateral thorax oscillations a CWI score of 2 indicated upper and bibasilar thorax oscillations. We developed a chest wiggle index (CWI) score to assist therapists in assessing optimal treatment strategies. In our study, the efficacy of the therapy was determined by visible and tactile bilateral chest oscillations. Cost of the device ranges from $1,500 to $3,500. IPV is a combination therapy including components of incentive spirometry, hydration, bronchodilators, oscillatory PEP and positive inspiratory airway pressure. The clinician controls the amount of pressure and pulsatile flow by adjusting frequency and drive pressure. IPV THERAPY uses a device delivering positive percussive inspiratory/expiratory pressure which is not dependent on patient effort. In effect, the device is an oscillating PEP valve. The degree of chest wiggle and expiratory pressure is highly dependent on patient effort. This vibrates the bronchial walls and may help loosen secretions. If the patient exhales at a constant high flow, a steel ball in the pipe bowl oscillates and modulates a pressure gradient in the airway. The Flutter valve is a small hand-held, pipe-like device that capitalizes on a patient’s ability to generate relatively high expiratory flows over several seconds. Ten patients with either thick inspissated secretions and/or atelectasis were included in the study. WITH THAT THOUGHT in mind, Montana clinicians set up a study comparing IPV and the Flutter device to determine the ability of the two devices to cause bilateral basal chest oscillations. While some studies have compared traditional, external CPT with some of the new equipment designed to start the process internally, to our knowledge, no study has previously been done to compare patient results using two of the newer devicesthe Flutter valve and IPV therapy. Proponents of each device strongly champion their own method. Among the devices used for this technique are PEP valve, Flutter valve and Intrapulmonary Percussive Ventilation (IPV). Recently, airway clearance techniques using internal assaults have been introduced to the respiratory care community. ![]() In some instances, it may not even be all that beneficial either, because extrathoracic assaults to the chest wall do not always allow vibrations to be transmitted to the lung parenchyma where it is needed. ![]() 1 shows CPT has only a short list of indications and may even be harmful. However, an extensive review of CPT by Eid et al. Traditionally, chest physical therapy (CPT) has been used in patients with diseases associated with production of copious secretions and atelectasis.
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