Chest Physiotherapy and Cystic Fibrosis: The Flutter VRP1
High-frequency chest compression (HFCC) has been shown to sustain ventilation and facilitate mucociliary clearance in anaesthetized dogs.” This therapy consists of an inflatable cuff or vest positioned around the subject’s thorax which is connected to a pump capable of producing an oscillating gas flow of 5 to 22 Hz. It is thought that each chest compression produces a transient rapid gas flow similar to those flows produced in spontaneous coughing High-frequency chest compression is currently conducted in the upright sitting position and with the subject initiating the device by means of a hand control. The subject is instructed to inhale to total lung capacity, then switch the HFCC device on, and exhale passively. This cycle is repeated for 5-min after which the subject huffs and coughs to expectorate secretions. High-frequency chest compression has been shown to facilitate secretion clearance in normal and CF subjects. Warwick and Hansen (1991) conducted a long-term evaluation (21.6 months) of HFCC as a replacement for conventional CPT. Percent predicted FEVi and forced vital capacity values were monitored for 16 CF subjects who replaced conventional CPT with HFCC, and 94% of subjects showed improvements in the progress of their respiratory impairment regardless of the severity of their lung disease. review
The Flutter VRP1 (Varioraw product l) is a new device aimed at promoting treatment independence for CF patients. The patient operates the device by exhaling against a resistance (5 to 35 cm H2O) generated by a small ball covering the opening of an enclosed upward widening cone. The movement of the ball during expiration creates an oscillatory frequency between 8 and 26 Hz. The mechanism of the technique appears to incorporate positive end-expiratory pressure, oral high-frequency oscillation, and active breathing exercises. Preliminary studies suggest that sputum expectoration is altered when using the Flutter device, but improvements in pulmonary function have not been shown. Pryor and Webber (1992) compared the use of the ACBT with and without the Flutter VRP1 in a group of 16 CF patients. Both treatment regimens resulted in improvements in FEVi and oxygen saturation, but the ACBT alone produced significantly greater sputum in treatment sessions. Pryor and Webber maintain that there is no additional advantage in including the use of the Flutter VRP1 and that the potential problem of sputum retention is a cause for concern.