Vibralung Indications & Intended Usage
Indications for Use. The Vibralung Acoustical Percussor is indicated as an airway secretion clearance device that creates vibrations in the airways and as a lung expansion device that applies Positive Expiratory Pressure (PEP) as a patient breathes through the device. It may be used to promote bronchial drainage, airway clearance and expectoration and to prevent or reverse atelectasis. Aerosol drug delivery may be used concomitantly with the Vibralung via an interface to the Westmed Circulaire II high-efficiency aerosol drug delivery system.
Patient Population. Cystic Fibrosis, COPD, asthma and lung diseases with secretory problems, patients with neuromuscular disease affecting the ability to effectively cough, and patients with or at risk of developing atelectasis. Anyone who is able to read and/or follow verbal instructions may use the Vibralung Acoustical Percussor.
Environment of Use. Hospital and home.
Clinical Application. The Vibralung Acoustical Percussor for patients with respiratory diseases and related conditions that involve:
- increased mucus production
- infection and inspissation of respiratory secretions
- defective mucociliary clearance
These conditions are typical in patients diagnosed with:
- cystic fibrosis
- chronic bronchitis
- ciliary dyskinesia syndromes
- muscular dystrophy
- post-operative atelectasis plus neuromuscular respiratory impairments
- thoracic bellows defects
- and any other cardiorespiratory or neuromuscular diseases that inhibit effective cough, mucokinesis, airway clearance and expectoration
Gentle ACT. The Vibralung Acoustical Percussor provides a “gentler” form of ACT than oscillatory PEP devices and devices that make contact with the external chest wall and may also be used for airway clearance in some conditions where other means of airway clearance (e.g., vests and hand-held chest percussors) cannot be used, such as with patients with chest injuries, burns, fresh surgical wounds or injured/broken ribs.
Contraindications. ACT or use of the Vibralung Acoustical Percussor, especially with Positive Expiratory Pressure, may be contraindicated in patients who have untreated air leaks, tension pneumothorax, bronchopleural fistula, recent hemoptysis, or pulmonary hemorrhage as it may exacerbate those conditions. Prescribers should weigh the benefits against the risks in patients with these conditions.
Adverse Reactions. If the patient complains of dry throat or mouth brought about by treatment with the Vibralung, consider adding nebulization with normal saline if it is not already being done. If the patient complains of sore mouth, jaw or teeth brought about by using the Vibralung device, the healthcare practitioner should assess the patient. If the patient complains of dizziness or light-headedness, assess the patient for possible hyperventilation while using the device. If the patient appears to be hyperventilating, pause the treatment and coach the patient to alter their breathing pattern appropriately. Any other adverse reactions should be fully assessed before continuing therapy with the Vibralung Acoustical Percussor.
Review of Airway Clearance Therapy
Airway Clearance Therapy is the contemporary name applied to a variety of techniques that are used to enhance mucokinesis. Mucokinesis is the normal movement of mucus from all depths of the lungs to the back of the throat, where it is either swallowed or spit out (expectorated). There are a number of respiratory diseases and conditions (see Clinical Applications, above) that involve increased mucus production, decreased mucokinesis, pooling and inspissation of mucus in the airways, plus infection of pooled mucus secretions. Infected or excessive mucus is frequently referred to as sputum or phlegm when therapeutic efforts are aimed at assisting a respiratory patient to effectively remove it.
The goal of ACT is to enhance mucokinesis and facilitate expectoration of sputum. A wide variety of ACT procedures are in common use, and include numerous manual (that is, “hands on”) techniques in the realm of chest physiotherapy (CPT), and the application of a number of respiratory therapy devices that have been devised for this purpose.
One of the natural physiological mechanisms for mucokinesis and expectoration is the cough, which vigorously vibrates the airways and subjects them to exceptionally high pressures (>100 cmH2O). Coughing both breaks the adhesive and cohesive bonds of mucus with the airway surface and propels the secretions up the airway toward the pharynx. Unfortunately, many patients with respiratory disease and excessive respiratory secretions are unable to muster an effective cough because it is often hindered by the disease itself or the inability to take a deep breath and produce sufficiently forceful cough pressures.
The fundamental goals of ACT are as follows:
- disrupt the interface of mucus with the airway surface to which it adheres
- enhance the lung’s inherent physiological mucociliary clearance mechanism
- generate sufficiently high airway pressure gradients to propel secretions outward
The typical methods for accomplishing these goals are as follows:
- vibrate the external chest wall, lung tissue and airways at a variety of frequencies
- vibrate the “column” of gas in the airways at a variety of frequencies
- alternately interrupt the flow of gas in the airways, particularly during exhalation, at a variety of frequencies
- apply Positive Expiratory Pressure (PEP) to the airways
- apply specific breathing techniques and maneuvers
- artificially induce a deep breath followed by an explosive expiratory breath
The Vibralung Acoustical Percussor applies PEP and vibrates the column of gas in the airways over a very wide range of frequencies in order to cause sympathetic resonance of the airways and airway secretions at an exceptionally wide range of frequencies, to gently treat airways of all sizes without external chest wall contact or complicated breathing maneuvers.