Chao Ta-Wei, Kao Ya-Chen, Liu Hui-Ling, Lin Sheng-Hsiang, Kuo Chin-Wei
Department of Respiratory Therapy, Department of Internal Medicine, National Cheng Kung University Hospital, Tainan, Taiwan.
Department of Internal Medicine, College of Medicine, National Cheng Kung University Hospital, National Cheng Kung University, Tainan, Taiwan.
BMC Pulm Med. 2025 May 3;25(1):214. doi: 10.1186/s12890-025-03685-y.
Pneumonia represents a significant global health burden with high morbidity and mortality rates, despite advances in therapeutic and preventive strategies. Airway clearance techniques (ACT), including High-Frequency Chest Wall Oscillation (HFCWO) and bilevel positive airway pressure (BiPAP), are critical in managing respiratory conditions. However, the combined effectiveness of BiPAP and HFCWO in treating adult pneumonia remains underexplored.
A retrospective cohort study was conducted at a college hospital in southern Taiwan, enrolling patients aged ≥ 18 years, admitted for pneumonia from January 2020 to December 2022, who received HFCWO therapy for ≥ 5 days in the ordinary ward. Exclusion criteria included prior mechanical ventilation before HFCWO initiation. Univariate and multivariable logistic regression models were used to assess the effectiveness of the combined use of BiPAP and HFCWO.
A total of 271 patients received HFCWO and were enrolled for analysis, including 163 patients who received both BiPAP and HFCWO. Patients receiving both BiPAP and HFCWO were associated with decreased frequency of sputum suction (OR: 2.91, 95% CI: 1.46-5.78, P = 0.002), and reduced oxygen need post-HFCWO (OR: 0.55, 95% CI: 0.33-0.91, P = 0.021). However, there was no difference in hospital stay, respiratory failure, ICU admission, or hospital death between the groups. Additionally, there was no difference in these outcomes for patients who received HFCWO twice daily compared to those who received it once daily.
Combining BiPAP and HFCWO reduces the need for sputum suction and improves oxygen demand for patients but does not change hospital days, respiratory failure, or mortality. Further large prospective cohort studies are necessary to confirm the efficacy of this management approach.
尽管治疗和预防策略取得了进展，但肺炎仍是全球重大的健康负担，发病率和死亡率都很高。气道清除技术（ACT），包括高频胸壁振荡（HFCWO）和双水平气道正压通气（BiPAP），在管理呼吸道疾病方面至关重要。然而，BiPAP和HFCWO联合治疗成人肺炎的综合效果仍未得到充分研究。
在台湾南部的一家大学医院进行了一项回顾性队列研究，纳入年龄≥18岁、2020年1月至2022年12月因肺炎入院、在普通病房接受HFCWO治疗≥5天的患者。排除标准包括在开始HFCWO之前曾接受机械通气。采用单因素和多因素逻辑回归模型评估BiPAP和HFCWO联合使用的有效性。
共有271例患者接受了HFCWO并纳入分析，其中163例患者同时接受了BiPAP和HFCWO。同时接受BiPAP和HFCWO的患者吸痰频率降低（OR：2.91，95%CI：1.46 - 5.78，P = 0.002），HFCWO后氧气需求减少（OR：0.55，95%CI：0.33 - 0.91，P = 0.021）。然而，两组之间的住院时间、呼吸衰竭、入住重症监护病房或医院死亡情况并无差异。此外，与每天接受一次HFCWO的患者相比，每天接受两次HFCWO的患者在这些结局方面也没有差异。
BiPAP和HFCWO联合使用可减少患者的吸痰需求并改善氧气需求，但不会改变住院天数、呼吸衰竭或死亡率。需要进一步开展大型前瞻性队列研究来证实这种管理方法的疗效。
