![]() ![]() During exhalation through the instruments, the steel ball vibrates while braking the expiratory flow, thereby provoking air-flow oscillations and PEP. They all have a removable perforated cap with a steel ball inside that is positioned on a conical cavity. The Flutter, Gelomuc, Pari, and Shaker devices have a pipe-like design and behave similarly. This study was performed at Cliniques universitaires Saint-Luc, Brussels, Belgium. Pohl-Boskamp GmbH, Hohenlockstedt, Germany) and 2 gravity-independent OPEP devices: Aerobika (Trudell Medical International, London, Ontario, Canada) and Acapella Choice (Smith's Medical, Ashford, Kent, United Kingdom). ![]() We tested 4 gravity-dependent OPEP devices: Flutter VRP1 (Scandipharm, Birmingham, Alabama), Shaker Medic Plus (NCS Indústria e Comércio de Aparelhos Hospitalares LTDA, Baruerí, São Paulo, Brazil), Pari O-PEP (PARI Medical, Surrey, United Kingdom), and Gelomuc (G. We focused on commercially available, demountable, and easy to disinfect OPEP devices that are suitable for use in patients with chronic respiratory diseases. We hypothesized that performance characteristics (ie, the likelihood of achieving oscillation frequency ≥ 12 Hz and PEP ≥ 10 cm H 2O) differ between devices. Therefore, the purpose of this study was to characterize the mechanistic properties of 6 OPEP devices at different resistance settings and submitted to various expiratory flow curve patterns. In vitro studies measuring and comparing mechanical effects of different OPEP devices by changing resistance settings, expiratory flows, and expiratory waveforms may help improve their use. 15 In these conditions, suboptimum OPEP utilization is likely, which may, in turn, affect therapeutic efficacy. 10, 12– 14 In addition, between-device differences may interact with varying expired air-flow patterns obtained from patients with diverse conditions or disease severity. Indeed, their mechanical effects such as PEP, oscillation frequency, and oscillation amplitude are strongly dependent on how the devices are used (eg, position, resistance settings, expiratory flow). Because many devices are manufactured with specific technology to produce air-flow oscillations, it is unclear whether the desired physiological effects are achieved when a subject exhales through a particular device adjusted at a given resistance level. Theoretically, optimized OPEP utilization should generate oscillations of ≥ 12 Hz 9, 10 while reaching a minimum PEP of 10 cm H 2O 11 to achieve the above-mentioned physiological effects. 3 Beyond methodological considerations, these findings may partly result from mechanistic differences between OPEP devices. However, clinical studies comparing the efficacy of various OPEP devices have failed to report the superiority of any one technique over another. Hence, air-flow oscillations facilitate mucociliary clearance. ![]() Moreover, turbulent air-flow spikes that are elicited reduce mucus viscoelasticity and promote its detachment and cephalad movement. 4 Second, air-flow oscillations attempt to stimulate ciliary beat frequency and coincide with the respiratory system resonance frequency. First, positive expiratory pressure (PEP) is generated and stabilizes the airways by means of a pneumatic splint to prevent early airway collapse during expiratory efforts. 2, 3 Basic principles of OPEP involve an expiratory oscillating air-flow brake, thereby inducing 2 main physiological effects. To assist airway clearance, oscillatory positive expiratory pressure (OPEP) devices are frequently applied in clinical practice, and numerous research studies have investigated their functioning and efficacy. 1 By speeding up the elimination of excessive phlegm obstructing the lung, these techniques are used to limit the occurrence of recurrent pulmonary exacerbations and to stabilize the decline of lung function. Airway clearance techniques account for a substantial part of the chest physiotherapy treatment arsenal in patients with chronic suppurative lung diseases, such as cystic fibrosis or non-cystic fibrosis bronchiectasis.
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