secretion management - smiths medical

Secretion Management

Open Airways

OPEN THROUGH SECRETION MANAGEMENT

HOW CAN AIRWAYS BE KEPT OPEN?

Managing acute and chronic respiratory illness involves many therapeutic treatments but always includes one strategic objective: keeping airways open. One of the most effective ways to open airways, and to keep them open, is to manage secretions.

Effective secretion management – detection, hydration, mobilisation, removal, and collection of excessively thick respiratory secretions – helps to improve or preserve respiratory health and achieve positive patient outcomes.

Smiths Medical would like to bring about changes in secretion management. From the hospital to home care, our approach is clinically orientated.

In acute care settings, pulmonary therapy is important for patients at risk for atelectasis. A study conducted at the University of Pittsburgh concluded that the implementation of a respiratory therapy protocol can decrease the number of days spent on mechanical ventilation and in intensive care, and lower hospital costs.1

WHAT ARE THE BENEFITS OF PEP THERAPY?

Positive airway pressure (PAP) therapy, which also includes positive expiratory pressure (PEP) therapies, is used as part of a vast therapy program. This ranges from bronchial hygiene to the mobilisation and removal of secretions, in particular in patients suffering from atelectasis, asthma, COPD, and cystic fibrosis. PEP can:

• Reduce air trapping common with asthma and COPD

• Help to mobilise secretions in cystic fibrosis and chronic bronchitis patients

• prevent or reverse atelectasis

• Optimise the delivery of bronchodilators

Smiths Medical’s tailored solutions can provide these therapeutic benefits across the continuum of care.

WHAT THERAPIES ARE EFFECTIVE?

Based on recent clinical studies, today we know that there are effective therapies tailored to specific respiratory needs: post operatively, to prevent and reduce atelectasis, for COPD, and for cystic fibrosis.

SMITHS MEDICAL WOULD LIKE TO BRING ABOUT CHANGES IN SECRETION MANAGEMENT. FROM THE HOSPITAL TO HOME CARE, OUR APPROACH IS CLINICALLY ORIENTATED

Post-operative / atelectasis 2,12-14 COPD 2, 4-9 Cystic fibrosis 2-4, 10, 11

Vibratory PEP therapy

PEP therapy

PAP therapy (periodic or continuous)

Chest physiotherapy

Incentive spirometry

EFFECTIVE THERAPIES

acapella® Vibratory PEP Therapy System

TheraPEP® PEP Therapy System

EzPAP® Continuous Positive Airway Pressure Therapy System

Coach 2® and CliniFLO® Incentive spirometry

SECRETION MANAGEMENT FROM SMITHS MEDICAL

POST-OPERATIVE PULMONARY COMPLICATIONS

Post-operative pulmonary complications (POPCs) are broadly defined as the diseases affecting the airways that can impede the clinical course of a patient after surgery. Divided into two categories, with patient-related and procedure-related factors, the POPCs have a multifactorial etiology and are associated with many pre-operative, intra-operative, and post-operative risk factors. Patients with POPCs may suffer from atelectasis, reduced oxygenation, and pneumonia.

Clinical scenario

Criteria Benefits of treatment Results


Patients with a history of chronic secretions/hypersecretions

• Reduces the viscosity of secretions that can cause atelectasis or an infection

Versatile therapy that the patient can receive sitting or reclining

• Easy to use• Facilitates high patient compliance• Can be self-administered

Patient unable to eliminate secretions, shortness of breath

• Can be used with EzPAP® if the patient needs to remove persistent secretions


For patients who are capable of taking a deep breath and self-administering their therapy, the TheraPEP® System can improve air circulation by allowing air to enter the lungs and get behind the mucus to push it towards the central airways. Use of this system enhances patient comfort by facilitating breathing and can reduce the need for more invasive treatments.

The patient has a high risk of developing atelectasis (chronic obstructive pulmonary disease (COPD), congestive heart failure, age, type and length of the surgical intervention)

• Highly effective for preventing or reversing atelectasis without other risks for the patient

The periodic administration of treatment by mask with a commercially available PEP device produces better results than incentive spirometry in terms of gas exchange, lung volume preservation, and the development of atelectasis after upper abdominal surgery. PEP therapy is also preferable to nasal continuous positive pressure (CPP) as it is portable, not limited to intensive care, and can be safely self-administered.12

The patient exhibits inappropriate inspiratory volumes

• PEP therapy is an expiratory manoeuvre that will open up the alveoli

Impaired oxygenation • Improves the partial pressure of oxygen in arterial blood (PaO2) and oxygen saturation

Versatile therapy • Self-administered

Reduced pulmonary function • Improves pulmonary function

Incentive spirometry not recommended• Complies with recommendations issued

by clinical societies such as the AARC for PEP therapies


When lung expansion is necessary and incentive spirometry alone is not enough to open up a patient’s airways, the EzPAP® System makes it possible to apply positive pressure throughout the breathing cycle. For patients exhibiting an increase in respiratory effort, breathlessness, or a drop in saturation, this is a treatment option that can easily be used to prevent and treat atelectasis.

Presence of atelectasis• Positive Airway Pressure therapy reverses

atelectasis by opening up collapsed alveoli by stenting and collateral ventilation

The EzPAP® Positive Airway Pressure System is a versatile tool that the physiotherapist can use to increase lung volumes, eliminate secretions, and improve gas exchange. As patient compliance is high, rapid clinical improvements have been observed. Following treatment with the EzPAP® System, 12% of the patients studied exhibited a more effective cough for eliminating secretions.13

Compared with the incentive spirometry control group in which patients showed a 25% improvement in their atelectasis, the EzPAP® group showed a 100% improvement. The EzPAP® System demonstrated a measurable improvement in coronary artery bypass graft (CABG) patients with post-surgical atelectasis and should be considered a viable option for pulmonary management of this population.14

Increased oxygen needs • Increases the functional residual capacity (FRC)

Inability to breathe in • Amplifies inhalation so that respiratory effort is more easily controlled

Breathlessness/increase in respiratory effort • Adjustable flow to control respiratory effort

Hospitalised patient • Less constraints than with the other therapies

Versatile

• Easy to administer• Passive participation by the patient• Can be administered with a mask

or a mouthpiece


An adjunct to deep breathing techniques • Can prevent atelectasis




Patients with a history of chronic secretions/hypersecretions

• Reduces the viscosity of secretions that can cause atelectasis or an infection

Versatile therapy that the patient can receive sitting or reclining

• Easy to use• Facilitates high patient compliance• Can be self-administered

Patient unable to eliminate secretions, shortness of breath

• Can be used with EzPAP® if the patient needs to remove persistent secretions


For patients who are capable of taking a deep breath and self-administering their therapy, the TheraPEP® System can improve air circulation by allowing air to enter the lungs and get behind the mucus to push it towards the central airways. Use of this system enhances patient comfort by facilitating breathing and can reduce the need for more invasive treatments.

The patient has a high risk of developing atelectasis (chronic obstructive pulmonary disease (COPD), congestive heart failure, age, type and length of the surgical intervention)

• Highly effective for preventing or reversing atelectasis without other risks for the patient

The periodic administration of treatment by mask with a commercially available PEP device produces better results than incentive spirometry in terms of gas exchange, lung volume preservation, and the development of atelectasis after upper abdominal surgery. PEP therapy is also preferable to nasal continuous positive pressure (CPP) as it is portable, not limited to intensive care, and can be safely self-administered.12

The patient exhibits inappropriate inspiratory volumes

• PEP therapy is an expiratory manoeuvre that will open up the alveoli

Impaired oxygenation • Improves the partial pressure of oxygen in arterial blood (PaO2) and oxygen saturation

Versatile therapy • Self-administered

Reduced pulmonary function • Improves pulmonary function

Incentive spirometry not recommended• Complies with recommendations issued

by clinical societies such as the AARC for PEP therapies


When lung expansion is necessary and incentive spirometry alone is not enough to open up a patient’s airways, the EzPAP® System makes it possible to apply positive pressure throughout the breathing cycle. For patients exhibiting an increase in respiratory effort, breathlessness, or a drop in saturation, this is a treatment option that can easily be used to prevent and treat atelectasis.

Presence of atelectasis• Positive Airway Pressure therapy reverses

atelectasis by opening up collapsed alveoli by stenting and collateral ventilation

The EzPAP® Positive Airway Pressure System is a versatile tool that the physiotherapist can use to increase lung volumes, eliminate secretions, and improve gas exchange. As patient compliance is high, rapid clinical improvements have been observed. Following treatment with the EzPAP® System, 12% of the patients studied exhibited a more effective cough for eliminating secretions.13

Compared with the incentive spirometry control group in which patients showed a 25% improvement in their atelectasis, the EzPAP® group showed a 100% improvement. The EzPAP® System demonstrated a measurable improvement in coronary artery bypass graft (CABG) patients with post-surgical atelectasis and should be considered a viable option for pulmonary management of this population.14

Increased oxygen needs • Increases the functional residual capacity (FRC)

Inability to breathe in • Amplifies inhalation so that respiratory effort is more easily controlled

Breathlessness/increase in respiratory effort • Adjustable flow to control respiratory effort

Hospitalised patient • Less constraints than with the other therapies

Versatile

• Easy to administer• Passive participation by the patient• Can be administered with a mask

or a mouthpiece


An adjunct to deep breathing techniques • Can prevent atelectasis

0%

20%

40%

60%

80%

100%

Incentive spirometry n=20EzPAP n=30

Improvement in post-surgical atelectasis in CABG patients

TheraPEP® PEP Therapy System EzPAP® Continuous Positive Airway Pressure Therapy System




The acapella® System combines the benefits of both PEP therapy and airway vibrations to mobilise pulmonary secretions that can occlude the airways, reduce pulmonary function, and cause infections. For patients with chronic secretion problems, this will both reduce the viscosity of their sputum and increase the sputum expectoration. Consequently, this will allow patients to breathe more easily and reduce the risk of infections.

Chronic secretions or hypersecretions

• The vibrations reduce viscosity and release the secretions

• Secretion removal reduces infections and occlusion

Sputum production facilitated through vibrations or non-vibratory PEP in patients characterised by abundant airway secretions. In patients with respiratory insufficiency, the techniques that apply a positive pressure to the airways can reduce the necessity or the duration of non-invasive positive pressure ventilation and hospitalisation.7

In comparison with respiratory training for sputum clearance, the acapella® System control group produced significantly more sputum and expressed a preference for this methodology.5

Air trapping associated with chronic secretions/hypersecretions

• PEP therapy• Acts like a stent, opening up the airways• Collateral ventilation creates a pressure

flow behind the mucus

Versatile• Self-administered by the patient• Suitable for home use; high compliance

Drug administration • Increase in particle deposition, combination of two treatments in one

Low expiratory flow • Multiple device options


For patients suffering from occasional secretion problems, the TheraPEP® System can improve air circulation by allowing air to enter the lungs and get behind the mucus to push it towards the central airways. Use of this system enhances patient comfort by facilitating breathing and can reduce the need for more invasive treatments.

Air trapping• PEP therapy• Acts like a stent, opening up the airways;

collateral ventilation

Treatment with a simple PEP device can reduce morbidity in patients with chronic bronchitis and may preserve lung function from a more rapid decline.6Impaired gas exchange • Increases FRC

Compromised pulmonary function • Preserves pulmonary function

Transitional care between the hospital & home • Helps to avoid readmission to hospital

The patient is claustrophobic • Can be administered with a mask or a mouthpiece

Versatile• Self-administered by the patient• Simple equipment

Exacerbations • Can prevent exacerbations


Patients in clinical difficulty exhibiting a drop in oxygenation, increased oxygen needs and/or an increase in respiratory effort

• PEP therapy during exhalation• Acts like a stent, opening up the airways• Facilitates collateral ventilation

Hospitalised patient • Air or oxygen is used to provide an additional flow in order to boost inhalation

Patient incapable of taking a deep breath • Provides inspiratory boost when patient has difficulty breathing in

CHRONIC OBSTRUCTIVE PULMONARY DISEASE

Most patients diagnosed with chronic obstructive pulmonary disease (COPD) have chronic bronchitis and emphysema, and this means that they have secretion problems associated with airway obstruction. Some patients also suffer from bronchiectasis.

Clinical scenario




The acapella® System combines the benefits of both PEP therapy and airway vibrations to mobilise pulmonary secretions that can occlude the airways, reduce pulmonary function, and cause infections. For patients with chronic secretion problems, this will both reduce the viscosity of their sputum and increase the sputum expectoration. Consequently, this will allow patients to breathe more easily and reduce the risk of infections.

Chronic secretions or hypersecretions

• The vibrations reduce viscosity and release the secretions

• Secretion removal reduces infections and occlusion

Sputum production facilitated through vibrations or non-vibratory PEP in patients characterised by abundant airway secretions. In patients with respiratory insufficiency, the techniques that apply a positive pressure to the airways can reduce the necessity or the duration of non-invasive positive pressure ventilation and hospitalisation.7

In comparison with respiratory training for sputum clearance, the acapella® System control group produced significantly more sputum and expressed a preference for this methodology.5


• PEP therapy• Acts like a stent, opening up the airways• Collateral ventilation creates a pressure

flow behind the mucus

Versatile• Self-administered by the patient• Suitable for home use; high compliance

Drug administration • Increase in particle deposition, combination of two treatments in one

Low expiratory flow • Multiple device options


For patients suffering from occasional secretion problems, the TheraPEP® System can improve air circulation by allowing air to enter the lungs and get behind the mucus to push it towards the central airways. Use of this system enhances patient comfort by facilitating breathing and can reduce the need for more invasive treatments.

Air trapping• PEP therapy• Acts like a stent, opening up the airways;

collateral ventilation

Treatment with a simple PEP device can reduce morbidity in patients with chronic bronchitis and may preserve lung function from a more rapid decline.6Impaired gas exchange • Increases FRC

Compromised pulmonary function • Preserves pulmonary function

Transitional care between the hospital & home • Helps to avoid readmission to hospital

The patient is claustrophobic • Can be administered with a mask or a mouthpiece

Versatile• Self-administered by the patient• Simple equipment

Exacerbations • Can prevent exacerbations


Patients in clinical difficulty exhibiting a drop in oxygenation, increased oxygen needs and/or an increase in respiratory effort

• PEP therapy during exhalation• Acts like a stent, opening up the airways• Facilitates collateral ventilation

Hospitalised patient • Air or oxygen is used to provide an additional flow in order to boost inhalation

Patient incapable of taking a deep breath • Provides inspiratory boost when patient has difficulty breathing in

*Forced expiratory volume, 1 second

SymptomsNo. of acute

exacerbationsNo. of days on

antibioticsExpectorants FEV1* FVC VC

Control group No change 12 74

PEP group Less coughing, less mucus production, less dyspnea 3 21

Conclusion: After 12 months




The acapella® System combines the benefits of both PEP therapy and airway vibrations to mobilise pulmonary secretions that can occlude the airways, reduce pulmonary function, and cause infections. In patients capable of standing, sitting, or reclining, this treatment may be better tolerated and reduce therapy time, compared to other respiratory physiotherapy techniques.

Chronic secretions or hypersecretions • The vibrations reduce viscosity and release or dislodge the secretions. The vibration frequencies of PEP therapy

and the acapella® System are within the amplitude that has been demonstrated to improve secretion removal. This is a tangible proof of its beneficial impact when used in physiotherapy on patients suffering from cystic fibrosis.11

Airway clearance therapy is recommended for all patients suffering from cystic fibrosis in order to eliminate sputum, maintain pulmonary function, and improve the quality of life.4


• PEP therapy acts like a stent and keeps airways open

• Facilitates collateral ventilation

Drug administration • Combines the effects of PEP and drug administration

Age 4 and up

• Self-administered by the patient• Suitable for home use• High compliance• Versatile

Necessity of multiple treatments

• Disassembled and cleaned in compliance with the recommendations of the CF Foundation

• Dual therapy. TheraPEP can be be used between use of acapella to provide a dual therapy


Designed to apply positive expiratory pressure therapy, the TheraPEP® System allows air to enter the lungs and get behind the mucus to push it towards the central airways. It is completely portable.

Secretions• Mobilises distal airway secretions towards

the central airways• Applies distal pressure to the secretions

In patients with cystic fibrosis, positive expiratory pressure breathing increases lung volumes in relation to the expiratory pressure imposed; this opens up collateral pathways or small airways in obstructed parts of the lungs.10

In patients with cystic fibrosis, PEP is recommended as compared with conventional respiratory physiotherapy, as it is roughly as effective, affordable, safe, and can be self-administered.3

Age 4 and up

• Easy to use• Self-administered by the patient• Suitable for home use • Compact and portable; facilitates high

patient compliance


• Treatment used in addition to other devices for clearing the airways

• PEP therapy acts like a stent to open up the airways and provides collateral ventilation

• Passive action method for patients who cannot follow their treatment independently


Can be appropriate during periods of exacerbation with an increase in respiratory effort

• Avoids more invasive therapies

CYSTIC FIBROSIS

Cystic fibrosis is a genetic disease that results in the formation of thick, viscous mucus in the lungs, the pancreas, and other organs. When the mucus invades the lungs, the airways are occluded, resulting in pulmonary lesions, breathing difficulties, and infections. Bronchiectasis (dilation of the bronchioles) can be a component of cystic fibrosis, creating a vicious circle of excessive secretions that invade the mucociliary clearance system and obstruct the airways, sometimes causing infections. When the pulmonary problems associated with cystic fibrosis cannot be treated, the use of appropriate devices can alleviate the symptoms and help to maintain the quality of life.

Clinical scenario




The acapella® System combines the benefits of both PEP therapy and airway vibrations to mobilise pulmonary secretions that can occlude the airways, reduce pulmonary function, and cause infections. In patients capable of standing, sitting, or reclining, this treatment may be better tolerated and reduce therapy time, compared to other respiratory physiotherapy techniques.

Chronic secretions or hypersecretions • The vibrations reduce viscosity and release or dislodge the secretions. The vibration frequencies of PEP therapy

and the acapella® System are within the amplitude that has been demonstrated to improve secretion removal. This is a tangible proof of its beneficial impact when used in physiotherapy on patients suffering from cystic fibrosis.11

Airway clearance therapy is recommended for all patients suffering from cystic fibrosis in order to eliminate sputum, maintain pulmonary function, and improve the quality of life.4


• PEP therapy acts like a stent and keeps airways open

• Facilitates collateral ventilation

Drug administration • Combines the effects of PEP and drug administration

Age 4 and up

• Self-administered by the patient• Suitable for home use• High compliance• Versatile


• Disassembled and cleaned in compliance with the recommendations of the CF Foundation

• Dual therapy. TheraPEP can be be used between use of acapella to provide a dual therapy


Designed to apply positive expiratory pressure therapy, the TheraPEP® System allows air to enter the lungs and get behind the mucus to push it towards the central airways. It is completely portable.

Secretions• Mobilises distal airway secretions towards

the central airways• Applies distal pressure to the secretions

In patients with cystic fibrosis, positive expiratory pressure breathing increases lung volumes in relation to the expiratory pressure imposed; this opens up collateral pathways or small airways in obstructed parts of the lungs.10

In patients with cystic fibrosis, PEP is recommended as compared with conventional respiratory physiotherapy, as it is roughly as effective, affordable, safe, and can be self-administered.3

Age 4 and up

• Easy to use• Self-administered by the patient• Suitable for home use • Compact and portable; facilitates high

patient compliance


• Treatment used in addition to other devices for clearing the airways

• PEP therapy acts like a stent to open up the airways and provides collateral ventilation

• Passive action method for patients who cannot follow their treatment independently


Can be appropriate during periods of exacerbation with an increase in respiratory effort

• Avoids more invasive therapies

PEP 5cm H2O PEP 15cm H2O

012345678

Baselinelevel During After During After

Functional residual capacityTotal lung capacity

Thoracic gas volume liters (average)


THE RESULTS15

EzPAP® PEP and PAP continuous positive pressure system

HOW DOES EZPAP® WORK AND WHAT ARE THE RESULTS?

Air

way

pre

ssur

e (c

m H

2O)

PEPLung expansion therapy

PAPPositive pressure aspiration therapy

PEP

Collateral ventilation

Coanda effect

4-fold multiplication of in flowing air

Product references

Part number Description Units/case

23-0747 EzPAP® System with mouthpiece 10

23-0757 EzPAP® System with mouthpiece and disposable manometer 10

23-1747 EzPAP® System with paediatric face mask 1

23-2747 EzPAP® System with medium face mask 1

23-3747 EzPAP® System with large face mask 1

CLOSE-UP OF RESPIRATORY THERAPY DEVICES AND SECRETION MANAGEMENT

22 mm OD patient connector for use with a mouthpiece or a face mask (3 sizes available)

Mask or mouthpiece option

Pressure port with detachable cap allows connection to a gauge for monitoring

Ambient air inlet with distal outlet specially designed to resist occlusion

Oxygen port connects via tubing to O2 flowmeter or wall-mounted O2

EzPAP® is a simple and effective “In-Hospital” method for delivering positive airway pressure throughout the breathing cycle. Though pressure does decrease during inhalation, it always remains positive, helping to open airways and re-inflate collapsed alveoli. EzPAP also provides the additional benefit of PEP therapy during exhalation, offering further rehabilitation to the patient.

FEATURES

acapella® Vibratory PEP therapy device

BENEFITSThe ideal partner for continuing treatment as soon as the patient returns home, acapella® duet and acapella® choice can be easily dismantled and cleaned for improved hygiene

FEATURES acapella®

duet

acapella®

choice

acapella®

DH

acapella®

DM

Works in any position – standing or sitting

Flow resistance and frequency levels adjustable with a dial

Treatment requires half as much time as conventional respiratory physiotherapy16

22 mm OD distal connector for connection to a nebuliser via a T piece

Ease of use of the built-in nebuliser connector

Compact design for an easy grip

Tethered protective cap helps reduce the risk of contamination when in the resting position

Easily dismantled for disinfection in boiling water, by autoclave, or in the dishwasher (top rack only)

Required patient expiratory flow rate 10 L / min



CLOSE-UP OF RESPIRATORY THERAPY DEVICES AND SECRETION MANAGEMENT

22 mm OD proximal connector allows use with a mouthpiece or a mask

Dial for flow resistance and frequency level adjustment

Corrugated connector serves as a drug reservoir

Standard format, built-in nebuliser connector accommodates most nebulisers (acapella® duet)

Clear material allows rapid visualisation of device cleanliness

One-way valve allows inhalation through the device without removal from the patient’s mouth

The acapella® family provides vibratory PEP therapy to clear secretions. These devices can be used in any position and provide the patient with both high and low flow rates options. The versatility of acapella allows the use of the device in hospital, at home or even in the work place.

FEATURES

Product references


27-900 acapella® duet kit, includes acapella® duet, mouthpiece, Portex® SVN, oxygen tubing, flexible tubing 10

27-9001 acapella® duet with mouthpiece 10

007760 Small volume medication nebuliser 50

27-7000 acapella® choice with mouthpiece 10

21-1015 acapella® DM – Low flow – color-coded blue 10

21-1530 acapella® DH – High flow – color-coded green 10

27-0050 Replacement mouthpiece fits all acapella® family models 50

Airway expiratory pressure indicatorVisual confirmation of pressure between 10-20 cm H2OAccurate readings in any position, at any angle

Detachable pressure monitoring port allows the use of the device with or without the pressure indicator for greater flexibility.

22 mm OD proximal male connector allows connection to a mouthpiece or a mask.

Inspiratory valve allows breathing without removing the device from the patient’s mouth

22 mm ID female adapter for use with aerosol diffusors22 mm ID male connector

Resistance valve

6 resistance orifice options

TheraPEP® is an alternative device for PEP therapy. This therapy can be self-managed by the patient and requires half the time of conventional respiratory physiotherapy.16 TheraPEP® can adapt to any lung capacity and enables inhalation and exhalation without having to be removed from the patient’s mouth. Thanks to its connector (22mm internal diameter) allowing for connection to a nebuliser or an inhalation chamber, it is the device of choice for clearance and treatment of atelectasis in the hospital or at home.

FEATURES

Product references


20-1112 TheraPEP® with mouthpiece 10

20-0005 Straight connector - ID 22 mm 10

20-0022 TheraPEP® - Pressure port, tubing, indicator 10

20-0050 TheraPEP® - Mouthpiece - ID 22 mm 50

TheraPEP® PEP therapy device

REFERENECES1. Harbrecht BG, Delgado E, Tuttle RP, Cohen-Melamed MH, Saul MI, Valenta CA. Improved Outcomes with Routine Respiratory Therapist Evaluation of Non-Intensive-Care-Unit surgery Patients.

Respiratory Care, July 2009 Vol 54 No 7 pages 861-867.2. AARC Clinical Practice Guideline: Use of PAP Adjuncts to Bronchial Hygiene Therapy, Respir Care 38(5):516-521, 1993.3. McCool D, Rosen M, Nonpharmacologic Airway Clearance Therapies: AACP Evidence Based Clinical Practice Guidelines. Chest. 2006;129;250-259.4. Flume PA, Robinson KA, O’Sullivan BP, et al. Cystic Fibrosis Pulmonary Guidelines; airway clearance therapies. Respir Care. Apr 2009; 54(4): 522-537.5. Naraparaju S, Vaishali K, Venkatesan P, Acharya V. A comparison of the acapella and a threshold inspiratory muscle trainer for sputum clearance in bronchiectasis-

A pilot study. Physiother Theory Pract. Aug 2010;26(6):353-357.6. Christensen EF, Nedergaard T, Dahl R. Long-term treatment of chronic bronchitis with positive expiratory pressure mask and chest physiotherapy. Chest. Mar 1990;97(3):645-650.7. Su CL, Chiang LL, Chiang TY, Yu CT, Kuo HP, Lin HC. Domiciliary positive expiratory pressure improves pulmonary function and exercise capacity in patients with chronic obstructive pulmonary

disease. J Formos Med Assoc. Mar 2007;106(3):204-211.8. Holland AE, Button BM. Is there a role for airway clearance techniques in chronic obstructive pulmonary disease? Chron Respir Dis. 2006;3(2):83-91.9. Hill K, Patman S, Brooks D. Effect of airway clearance techniques in patients experiencing an acute exacerbation of chronic obstructive pulmonary disease: a systematic review.

Chron Respir Dis. 2010;7(1):9-17.10. Van der Schans CP, Van der Mark TW, de Vries G, et al. Effect of positive expiratory pressure breathing in patients with cystic fibrosis. Thorax. Apr 1991;46(4):252-256.11. McCarren B, Alison JA. Physiological effects of vibration in subjects with cystic fibrosis. Eur Respir J. Jun 2006;27(6):1204-1209.12. Ricksten SE, Bengtsson A, Soderberg C, Thorden M, Kvist H. Effects of periodic positive airway pressure by mask on postoperative pulmonary function. Chest. Jun 1986;89(6):774-781.13. Elliott S. A study to investigate the clinical use and outcomes of EZPAP positive pressure device. Thorax. December 1, 2011 2011;66(Suppl 4):A96.14. Wiersgalla S. Effects of EzPAP postoperatively in coronary artery bypass graft patients. Paper presented at: 48th International Respiratory Congress for the AARC Annual

Convention and Exhibition 2002; Tampa, FL.15. Schaelte G, Rex S, Coburn M, Van den Hoff L, Rossaint R. Non-invasive ventilation (NIV) using a compact CPAP system for the treatment of postoperative hypoxaemia in the PACU. Klinik für

Anästhesiologie, Universitaetsklinikum der RWTH Aachen, Aachen, Germany. April 2009.16. Mahlmeister MJ et al. Positive-expiratory-pressure mask therapy: Theoretical and Practical Considerations and a Review of the Literature - Respiratory Care, 1991.

PRODUCT(S) DESCRIBED MAY NOT BE LICENSED OR AVAILABLE FOR SALE IN CANADA AND OTHER COUNTRIES

Smiths Medical International1500 Eureka Park, Lower PembertonAshford, Kent, TN25 4BFTel: +44 (0)845 850 0445

Find your local contact information at: www.smiths-medical.com/customer-support /contact-usSmiths Medical is part of the global technology business Smiths Group plc. Please see the Instructions for Use/Operator’s Manual for a complete listing of the indications, contraindications, warnings and precautions. Portex, acapella, EzPAP, TheraPEP, Coach 2, CliniFLO and the Smiths Medical and Portex logos are trademarks of Smiths Medical. The symbol ® indicates the trademark is registered in the U.S. Patent and Trademark Office and certain other countries. All other names and marks mentioned are the trademarks or service marks of their respective owners. ©2019 Smiths Medical. All rights reserved. RE194308GB-122019

MHYTCA-1050

Contact your sales representative at +44 (0)845 850 0445 orfor more information visit our website at www.smiths-medical.com

Smiths Medical, your partner in your new approach to secretion management

SMITHS MEDICAL OFFERS SOLUTIONS FOR SECRETION MANAGEMENT FOR HOSPITAL CARE, HOME CARE, AND LIFE.

We can help you achieve more effective interventions and enhanced outcomes with:• A complete portfolio of products for the treatment of chronic secretions and hypersecretions• Dedicated products for vibratory PEP and PAP therapies• A compendium of clinical works and evidence to support the clinical outcome objectives• Products that are easy to use with the added benefit of high patient compliance

Smiths Medical ASD, Inc.6000 Nathan Lane North, Minneapolis, MN 55442, USATel: 1-614-210-7300Toll-Free USA: 1-800-258-5361www.smiths-medical.com

secretion management - smiths medical

Documents