- Design
- Single-centre randomised controlled trial
- Population
- 88 adults with acute respiratory failure on non-invasive support, hypersecretion and peak cough flow below 270 L/min
- Primary outcome
- Need for therapeutic bronchoscopy
- Effect
- 13.6% vs 31.8%; adjusted OR 0.336 (0.111–1.021)
A single-centre randomised trial in an Italian respiratory intermediate care unit, published in Chest on 14 October, enrolled 88 patients with acute respiratory failure on high-flow nasal oxygen or non-invasive ventilation, who had bronchial hypersecretion and a weak cough (peak cough flow below 270 L/min). Half received high-frequency chest wall oscillation (HFCWO) with standard care.
Therapeutic bronchoscopy was needed in 14% with HFCWO and 32% without. After adjustment, this was no longer statistically significant. Exploratory outcomes favoured HFCWO: hospital stay about 4.5 days shorter and high-flow duration shorter. No one was intubated, and mortality did not differ.
Secretion retention often tips patients on non-invasive support towards bronchoscopy or intubation. The result is encouraging but too small and single-centre to change practice. Where the device is available, it is a reasonable adjunct while larger trials report.
- Measure peak cough flow in patients with secretions on non-invasive support; below 270 L/min signals weak clearance.
- Consider adding mechanical airway clearance for retained secretions, where available.
- Do not delay bronchoscopy when it is clinically needed on the basis of this trial.
- Treat the shorter hospital stays as hypothesis-generating.
Why it matters
Secretion clearance is a modifiable reason patients fail non-invasive support.
Don't overread it
The primary result lost significance after adjustment, and secondary outcomes were not corrected for multiple testing.
The statistics, in plain English
The adjusted odds ratio of 0.34 (95% CI 0.11 to 1.02) suggests a substantial reduction, but the interval just crosses 1, so chance cannot be excluded in a trial of 88 patients.
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