Annotated Bibliography: Miscellaneous

Cost Analysis

Respiratory illness persistently consumes a major proportion of U.S. healthcare dollars. A recent sharp increase in the prevalence, severity and mortality of chronic respiratory conditions is cause for heightened concern. Appropriate use of airway clearance therapies including high frequency chest compression (HFCC) may yield significant reductions in annual care costs.



1. Chiappetta A, Mendendez A, Gozal D, Kiernan M. High-frequency chest wall oscillation in hospitalized non-cystic fibrosis patients. Am J Respir Crit Care Med 1996; 153:A56.
A retrospective medical chart review of 300 hospitalized non-cystic fibrosis patients (diagnoses unspecified) receiving professionally administered percussion and postural drainage (P& and PD) treatments for secretion clearance found that a significant proportion of those costly treatments could have been effectively replaced with high frequency chest compression (HFCC), thus providing a substantial savings in professional time, effort, and costs.


2. Klous DR, Boyle M, Hazelwood A, McComb RC. Chest vest & CF: Better care for patients. Adv Mgrs Respir Care 1993; 2(3):45-50.
This early report (1993) by respiratory care managers includes a six month cost/benefit of high frequency chest compression (HFCC) therapy in the in-patient setting. Using departmental quality assurance data, the mean number and session times of standard chest physiotherapy (CPT) were compared with the HFCC then being used for 55% of cystic fibrosis (CF) in-patients. Data analysis showed that by replacing 600 CPT treatments per month with HFCC, staff time savings of 236 hours would translate into a labor displacement of 2.85 full time equivalencies. (FTE). Advantages of HFCC included perceived effectiveness, patient satisfaction and increased ability of users to self-manage their CF.


3. Ohnsorg F. A cost analysis of high-frequency chest-wall oscillation in cystic fibrosis. Am J Respir Crit Care Med 1994; 149(4 pt.):A669.
BlueCross and BlueShield of Minnesota (BCBS/MN) conducted this retrospective record review of 23 cystic fibrosis (CF) clients to assess the impact of high frequency chest compression (HFCC) therapy on total healthcare expenditures. Respiratory-illness related costs incurred during one year of HFCC treatment, including the cost of the device itself, were compared with costs for the previous year. Data showed an aggregate reduction of 49% in total direct respiratory care costs during the year of HFCC use.

HFCC, Fitting and Tuning

Strategies to individualize and automate high frequency chest compression (HFCC) protocols may improve treatment efficiency and efficacy

1. Budd JR, Warwick WJ. Fitting and tuning a bronchial drainage high frequency chest compression device. Am Rev Respir Dis 1990; 141: A 814.
Shortly after high frequency chest compression devices became available for clinical use, the inventor and a colleague devised a protocol to ensure maximum efficacy for individual patients. The method, used for the first 64 HFCC patients 1) determined proper jacket fit by using measures of airflow at the mouth to find comparable peak flows for all lung volumes and 2) ascertained best therapeutic frequencies by selecting a mixture that achieved best frequencies for a) average induced peak flow b) the volume of air moved at the mouth for each air pump pulse.

2. Milla CE, Hansen LG, Warwick WJ. Different frequencies should be prescribed for different high frequency chest compression machines. Biomed Instrum Technol 2006; 40 (4): 319-324.
HFCC treatment frequencies may be prescribed according to the manufacturers' generic guidelines or may be determined for each individual patient by a "tuning" method that measures, at the mouth, the air volume displacement and the associated airflows produced at each frequency. This paper describes a protocol for finding the best frequencies and pressures for individual patients based upon a sample of 100 consecutive tunings. Data showed that every frequency from 6 and 20 Hz was a best frequency for at least one patient.

Research and Evidence

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