Anderson Casandra A, Palmer Cassandra A, Ney Arthur L, Becker Brian, Schaffel Steven D, Quickel Robert R
Surgery Department, Hennepin County Medical Center, Minneapolis MN, USA.
Clinical Research, Hill-Rom, St Paul MN, USA.
J Trauma Manag Outcomes. 2008 Oct 6;2(1):8. doi: 10.1186/1752-2897-2-8.
Airway clearance is frequently needed by patients suffering from blunt chest wall trauma. High Frequency Chest Wall Oscillation (HFCWO) has been shown to be effective in helping to clear secretions from the lungs of patients with cystic fibrosis, bronchiectasis, asthma, primary ciliary dyskinesia, emphysema, COPD, and many others. Chest wall trauma patients are at increased risk for development of pulmonary complications related to airway clearance. These patients frequently have chest tubes, drains, catheters, etc. which could become dislodged during HFCWO. This prospective observational study was conducted to determine if HFCWO treatment, as provided by The Vesttrade mark Airway Clearance System (Hill-Rom, Saint Paul, MN), was safe and well tolerated by these patients.
Twenty-five blunt thoracic trauma patients were entered into the study. These patients were consented. Each patient was prescribed 2, 15 minute HFCWO treatments per day using The Vest(R) Airway Clearance System (Hill-Rom, Inc., St Paul, MN). The Vest(R) system was set to a frequency of 10-12 Hz and a pressure of 2-3 (arbitrary unit). Physiological parameters were measured before, during, and after treatment. Patients were free to refuse or terminate a treatment early for any reason.
No chest tubes, lines, drains or catheters were dislodged as a result of treatment. One patient with flail chest had a chest tube placed after one treatment due to increasing serous effusion. No treatments were missed and continued without further incident. Post treatment survey showed 76% experienced mild or no pain and more productive cough. Thirty days after discharge there were no deaths or hospital re-admissions.
This study suggests that HFCWO treatment is safe for trauma patients with lung and chest wall injuries. These findings support further work to demonstrate the airway clearance benefits of HFCWO treatment.
钝性胸壁创伤患者经常需要进行气道清理。高频胸壁振荡（HFCWO）已被证明在帮助囊性纤维化、支气管扩张、哮喘、原发性纤毛运动障碍、肺气肿、慢性阻塞性肺疾病（COPD）等患者清除肺部分泌物方面是有效的。胸壁创伤患者发生与气道清理相关的肺部并发症的风险增加。这些患者经常有胸管、引流管、导管等，在HFCWO过程中可能会移位。本前瞻性观察研究旨在确定由The Vest商标气道清理系统（Hill-Rom，明尼苏达州圣保罗）提供的HFCWO治疗对这些患者是否安全且耐受性良好。
25例钝性胸部创伤患者进入本研究。这些患者均签署了知情同意书。每位患者每天使用The Vest气道清理系统（Hill-Rom公司，明尼苏达州圣保罗）进行2次，每次15分钟的HFCWO治疗。The Vest系统设置为频率10 - 12赫兹，压力2 - 3（任意单位）。在治疗前、治疗期间和治疗后测量生理参数。患者可因任何原因自由拒绝或提前终止治疗。
治疗过程中没有胸管、线路、引流管或导管移位。1例连枷胸患者在1次治疗后因浆液性胸腔积液增加而放置了胸管。没有错过任何治疗，且治疗继续进行，没有进一步的意外情况。治疗后调查显示，76%的患者经历了轻度疼痛或无疼痛，且咳嗽咳痰增多。出院30天后没有死亡病例或再次入院情况。
本研究表明，HFCWO治疗对肺和胸壁损伤的创伤患者是安全的。这些发现支持进一步开展工作以证明HFCWO治疗在气道清理方面的益处。
