- Design
- Single-centre randomised controlled trial
- Population
- 88 patients in a respiratory ICU with acute respiratory failure on non-invasive support, hypersecretion and weak cough
- Primary outcome
- Need for therapeutic bronchoscopy
- Effect
- 13.6% vs 31.8%; adjusted OR 0.34 (95% CI 0.11 to 1.02)
Patients on high-flow oxygen or non-invasive ventilation with retained secretions and an ineffective cough were randomised to standard care with or without high-frequency chest wall oscillation.
Fewer patients in the oscillation group needed bronchoscopy, but after adjustment this did not reach significance. Several secondary outcomes, including length of stay, favoured oscillation, but these were not corrected for multiple testing.
The trial is a reasonable basis for a larger study, not yet for routine use.
- Bronchoscopy was needed in 14% with oscillation against 32% without, before adjustment.
- After adjustment, the odds ratio was 0.34 with an interval crossing 1.
- Hospital stay was about 4.5 days shorter in exploratory analysis.
- High-flow nasal cannula duration was shorter and stayed significant after adjustment.
- No patient needed intubation, and mortality did not differ.
Why it matters
Secretion retention is a common reason non-invasive support fails, and an effective non-invasive clearance tool would be valuable.
Don't overread it
After adjustment the primary result was not significant, and shorter stays were exploratory secondary outcomes.
The statistics, in plain English
An adjusted odds ratio of 0.34 with an interval from 0.11 to 1.02 just includes no effect. The trial was small, so a real benefit may have been missed, or the unadjusted result may have been chance.
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