high frequency chest wall oscillations (hfcwo
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Jagtar Singh OBE - Chair Simon Gilby - Chief Executive
Coventry & Warwickshire Partnership NHS Trust Wayside House, Wilsons Lane, Coventry, CV6 6NY
Tel: 024 7636 2100 Fax: 024 7636 8949 www.covwarkpt.nhs.uk
HighFrequencyChestWallOscillations(HFCWO)&MechanicalInsufflation–Exsufflation(MI-E)Pathway
ThisdocumentrecommendscriteriatobeusedacrossCoventryandWarwickshirewhenrequestingfundingforhighfrequencychestwalloscillations(HFCWO)andmechanicalinsufflation-exsufflation(MI-E)forindividualpatientsalongsidetheavailableevidencebase.Thesedevicesareprovidedasstandardtreatmentinsomeareasforindividualswithneuromusculardisease(NMD)basedonrecommendedstandardsofcare(20,22,27,29).
HFCWOandMI-Earetypesofairwayclearancetechniquesusedbyrespiratoryphysiotherapiststoenhanceclearanceofexcessbronchialsecretions,totryandminimiseinfectionandthereforepreventrepeatedlungdamage.Thechild/youngperson(CYP)specificuseofthesetreatmenttechniquescanbetaughtbyarespiratoryphysiotherapist,tonurses,supportworkers,carersandfamiliesusingarespiratoryphysiotherapytreatmentplanaspartofacompetencytrainingpackage.
IfahealthcareprofessionalfeelstheHFCWO/MI-EmaybebeneficialfortheCYP,theymustdiscusswithmultidisciplinaryteam(MDT)includingtherespiratoryphysiotherapist.Arespiratoryassessmentmustbecarriedoutbyarespiratoryphysiotherapist.Ifacommunityrespiratoryphysiotherapistisnotavailable,fundingforaformalassessmentbyarespiratoryphysiotherapistmustbeagreedbyCCG.Devicecostsaredetailedinappendix1.
Device
CostofEquipment(excluding
VAT)
1yearsupplyconsumables Rentalcosts Warranty TrialLoan
period
NippyClearwayBreasMedical(MI-Edevice)
£3300.00 £160.00
£190.00permonth,minimumrental12
weeks
1year 2months
E70CoughAssistPhilips
(MI-Edevice)
£3,436.51-£3,702.91
£33.28
£380.00permonth
1year 1month
TheVestHill-Rom
(HFCWOdevice)
£6,995.00 Noinitialcost
£10.00perday
minimumrental3month
2year 3months
Jagtar Singh OBE - Chair Simon Gilby - Chief Executive
Coventry & Warwickshire Partnership NHS Trust Wayside House, Wilsons Lane, Coventry, CV6 6NY
Tel: 024 7636 2100 Fax: 024 7636 8949 www.covwarkpt.nhs.uk
1. InitialassessmentforHFCWO/MI-ETheCYPshouldbeassessedbyarespiratoryphysiotherapist(acuteorcommunity).ThechoiceofairwayclearancetechniqueisdecidedbytherespiratoryphysiotherapistandtheCYP/CYP’sfamily.Beforestarting,theremustbeclearindicationsandevidenceofotherairwayclearancetechniquesthathavebeentriedandhavenotbeeneffective.
CriteriaforHFCWO:TheHFCWOisusedtofacilitateairwayclearanceofsecretionsinCYPswhohaveacuteandchronicrespiratoryconditions.TheHFCWOrapidlyinflatesanddeflatesthevestcompressingandreleasingthechestwallcausinghighfrequencyoscillationswhichreplicatemini-coughs.Theseminicoughs,dislodgethemucusfromthewalloftheairwaysandwiththeincreasedstrengthoftheciliarybeatthroughresonance,helpstransportittothelargercentralairwaysforclearance.HFCWOmaybeconsidered:
• Acutechestinfectionwithsecretionretention• Chronicmucushypersecretionorsecretionretentionassociatedwithachronicpulmonary
orneuromuscularcondition• Alternativeairwayclearancetherapyprovenineffectiveorcontraindicatede.g.persistent
atelectasisdespitenormalairwayclearance• Longtermventilatedwithevidenceofsecretionretention• OngoingfatiguedespitetheinitiationofNIV,lackofstrengthorabilitytoperformactive
respiratoryphysiotherapytreatmente.g.activecycleofbreathing� Symptomatice.g.dailysecretionretention,recurrentrespiratoryinfections,SpO2<95%due
tosecretionretention,frequenthospitalisationse.g.threeormoreperannum,HDUandPICUadmissions,declineinlungfunction,regularantibiotics/steroidsrequiredforchestinfections
� Prolongedabsencefromschoolduetochestinfections.� Highburdenofcaree.g.siblingswithadditionalhealthcareneeds,otherdependants/
commitments,carerdisability,significantdependenceonchestphysiotherapyneed,relianceonotherstoassistwithmucusclearanceandphysicaldemandonpatientandcarerstoperformtreatment.
(1-17,36).
Appendix2haschartstoshowthecriteriaindicatedandtotalnumberofcriteriaforusingHFCWOinCYPinCoventryandWarwickshirePartnershipTrust(CWPT)andotherareasbetweenMarch2017andMay2018.InCWPT,thereare3CYPwhorequiredHFCWOandthetotalnumberofcriteriaindicatedwasbetween5and8.DatawasalsocollectedontheuseofHFCWOfromotherphysiotherapistsacrosstheUKworkingintheacutesectorandcommunity.Thetotalnumberofcriteriaindicatedfromotherareaswasbetween3and8.DuringthisdatacollectionitbecameevidentthatHFCWOisnotwidelyusedbytheothertrusts,andsoitwasdecidedtoonlyusethedatafromCWPTas3CYPareusingtheHFCWO.ItisthereforerecommendedthatifaCYPinCWPTmeets5ormoreofthecriteria,HFCWOmaybeconsidered.ThisisonlyaguideandclinicalreasoningshouldbeappliedwhenselectingappropriateairwayclearancedevicesfortheCYP.
Jagtar Singh OBE - Chair Simon Gilby - Chief Executive
Coventry & Warwickshire Partnership NHS Trust Wayside House, Wilsons Lane, Coventry, CV6 6NY
Tel: 024 7636 2100 Fax: 024 7636 8949 www.covwarkpt.nhs.uk
CriteriaforMI-E:IneffectivecoughisamajorcauseofmortalityandmorbidityinCYPwithNMD.Thisleadstorecurrentpulmonaryinfectionwhichcausesprogressivelungdamageandpoorrespiratoryfunction;andeventuallyrespiratoryfailure.MI-EisusedasadevicetoaidCYPtoclearretainedbroncho-pulmonarysecretions.MI-EisalsousedwithCYPwhohavedecreasedinspiratoryeffort,duetoeitherspinalcordinjuryorNMD;andwhohaveanimpairedorineffectivecoughwithappropriaterespiratorysymptoms.MI-Eisconsideredwhenconventionalcoughassistancetechniques(e.g.breathstacking,manualassistedcough)becomeineffective.MI-Einflatesthelungswithgradualpositiveairwaypressurefollowedbyarapidswitchtonegativeairwaypressure.Thissimulatestheflowchangesthatoccurduringacough,andassistsclearanceofsecretions.MI-Emaybeconsidered:
• Acutechestinfectione.g.chestexacerbation,increaseinsputum• Chronicmucushypersecretionorsecretionretentionassociatedwithaneuromuscular
condition• Ineffectivecoughorinabilitytoremovemucusbycoughing.Indicationsforstartingcough
assistancetechniquesforCYPwithneuromuscularweakness:o InCYP,whoareabletoperformareproducibleforcedexpiratoryflowmanoeuvre,a
forcedvitalcapacity<50%ofpredictedisanindicationforMIE.o Inadultswithneuromuscularweakness,aPCF(peakcoughflow)>160litres/minis
necessaryforeffectivesecretionclearanceandaPCF>270litres/minisassociatedwithresiliencetorespiratoryinfection.TheminimumPCFacceptedasnormalis400litres/minandisreachedbetween12-13yrs.Thereforeindicated:
§ Inchildren>12yrswhohaveaPCF<270litres/min,particularlyiftheyhavehadepisodesofdeteriorationwithrespiratoryinfection.
§ Inchildren>12yrs,PCF<160litres/minisastrongpredictorofseverechestinfections,respiratoryfailureandindicatethatCYPshouldstartassistedcoughingmethods,evenintheabsenceofrespiratorycomplicationsinthemedicalhistory
• Wherebreathstackingand/ormanualassistedcoughprovenineffectiveorcontraindicatede.g.osteopenia,persistentatelectasisdespitenormalairwayclearance
• Longtermventilatedwithevidenceofsecretionretention• Clinicalevidenceofhyperinflationand/orairtrapping� OngoingfatiguedespitetheinitiationofNIV,lackofstrengthorabilitytoperformactive
respiratoryphysiotherapytreatment.� Symptomatice.g.dailysecretionretention,recurrentrespiratoryinfections,SpO2<95%due
tosecretionretention,frequenthospitalisationse.g.threeormoreperannum,HDUandPICUadmissions,declineinlungfunction,regularantibiotics/steroidsrequiredforchestinfections
� Prolongedabsencefromschoolduetochestinfections.
Jagtar Singh OBE - Chair Simon Gilby - Chief Executive
Coventry & Warwickshire Partnership NHS Trust Wayside House, Wilsons Lane, Coventry, CV6 6NY
Tel: 024 7636 2100 Fax: 024 7636 8949 www.covwarkpt.nhs.uk
• Highburdenofcaree.g.siblingswithadditionalhealthcareneeds,otherdependants/commitments,carerdisability,significantdependenceonchestphysiotherapyneed,relianceonotherstoassist(18-36).
Appendix2haschartstoshowthecriteriaindicatedandtotalnumberofcriteriaforusingMIEinCYPinCWPTandotherareasbetweenMarch2017andMay2018.InCWPT,thereare4CYPwhorequiredMI-Eandthetotalnumberofcriteriaindicatedwasbetween6and9.Thetotalnumberofcriteriafromotherareasvariedbetween3to9.MI-Eisamorecommonlyuseddeviceanddatashowedacrosstheareasonaverage,theminimumnumberofcriteriaindicatedforusingMI-Ewas5ormore.ItisthereforerecommendedthatifaCYPinCWPTmeets5ormoreofthecriteria,MI-Emaybeconsidered.ThisisonlyaguideandclinicalreasoningshouldbeappliedwhenselectingappropriateairwayclearancedevicesfortheCYP.2. TrialPeriodTheHFCWO/MIEshouldonlybesetupandmodifiedbyatrainedrespiratoryphysiotherapist.TheRespiratoryPhysiotherapist’srolewillinclude:
• GainingagreementfromtheLeadconsultant–community/acute.ThereneedstobeanagreementthatthisleveloftreatmentisappropriateforlongtermusefortheCYPconsideringfactorssuchaspalliationbeforebeingdiscussedwithCYPandfamily.
• GainingconsentandcommunicationwithCYPandfamily• InformingCommunityChildren’sNurse(CCN)andcontinuingcaregroup/healthpanel.• Ifdevicestartedbyrespiratoryphysiotherapistintertiarycentre,needtoliaisewith
communityrespiratoryphysiotherapist.Ifcommunityrespiratoryphysiotherapistserviceunavailable,needtoconsiderhowtheCYPanddevicewillbemonitoredinthecommunity.
• Ifrecommendationispartofanewcontinuingcaresassessment,therespiratoryphysiowillprovidetheinformationtotheCCNtoincludeintheCYPassessment.
• InformotherhealthcareprofessionalsinvolvedinCYPcareasappropriate.• ArrangeloanequipmentfromHill-Rom,Philips,Nippybycompletingloanrequestformif
appropriate.• Providechildspecificrespiratoryphysiotherapytreatmentplantoincludebackup
treatmentifHFCWO/MI-Ebreaks.Tobewrittenbyrespiratoryphysiotherapist.• Arrangetrainingandcompletechildspecificcompetenciesforcarers/familymembersby
respiratoryphysiotherapist.• ConsiderwhereHFCWO/MI-Ewillbesetupandused:home/School/nursery/hospital/
hospice.• RespiratoryPhysiotherapisttodelivertrainingandcompletechildspecificcompetenciesfor
carers/familymembers• ProvideCYPfamilywithcontactnumbersforrespiratoryphysioandwhotocontactfor
consumablesifrequired.• Ifrentingdevice,additionalconsumableswillneedtobeaddedtorentalcosts.• Provideequipmentmanual&cleaninginstructionsplan.
Jagtar Singh OBE - Chair Simon Gilby - Chief Executive
Coventry & Warwickshire Partnership NHS Trust Wayside House, Wilsons Lane, Coventry, CV6 6NY
Tel: 024 7636 2100 Fax: 024 7636 8949 www.covwarkpt.nhs.uk
Outcomemeasures:Duringtheassessmentatthebeginningofthetrialbytherespiratoryphysiotherapist,appropriateoutcomemeasureswillbedefinedtogetthebestobjectivefeedbackontheeffectivenessofthetreatmentduringthetrialperiod.Appropriatemembersofthefamilyorcareteamwillbeaskedtorecordtheseobjectivemeasurestoenabletherespiratoryphysiotherapisttoassesstheresultsofthetrial.Thefollowingisanexampleofsomeobjectivemeasuresthatmightbeused:
ShortTermmeasures• Observationofrespiratorypattern&rate• Auscultation• Oxygensaturations• Cough• Peakcoughflow• Sputum• Ventilatorsettings• Oxygenrequirement• Numberofsuctions/cathetersused
LongTermmeasures• Lungfunctiontest(astheygetolderandifable)• Chestx-rayifable• ComplianceandCYPperspective• Lengthoftreatment• Exercisetolerance• Microbiology• Numberofhospitaladmissions• Numberofrespiratoryinfections• Numberofcoursesofantibioticsforrespiratoryinfection• Easeofteaching/learning• Burdenofcare• Numberofcarersrequiredtoperformtreatment• Costs(directandindirecttobeevaluatedpriortostartingdevicee.g.lengthofhospitalstay
withassociatedward,HDUorPICUbedcosts,antibioticcoursesandcosts.
3. TrialSuccessfulTherespiratoryPhysiotherapisttoinform:
• CCNandcontinuingcaregroup/healthpanel.• Companyandrequestaformalquoteincludingconsumablesforayearandservicing/
warranty.• OncefundingagreedbyCCG,informhealthcareprofessionalsinvolvedasappropriate.
Oncepurchased,HFCWO/MI-EtohaveassetnumberandPATtestedasrequiredbytrustpolicy.Ongoingmonitoring,trainingoffamily/carers,CYPassessmentandcompetencyyearlyreviewbyacuteorcommunityrespiratoryphysiotherapist.Annualserviceandmaintenanceofequipmentaspermanufacturer’sguidance.Ensureprovisionofconsumables
Jagtar Singh OBE - Chair Simon Gilby - Chief Executive
Coventry & Warwickshire Partnership NHS Trust Wayside House, Wilsons Lane, Coventry, CV6 6NY
Tel: 024 7636 2100 Fax: 024 7636 8949 www.covwarkpt.nhs.uk
AuthorAnnikaShepherd,ClinicalLeadRespiratoryPhysiotherapistCYPComplexPhysicalHealthServicesChildandFamilyServices,CWPTDate:October2018Specialthankstofollowingprofessionalsforcommentsandinformation:EmilyParry,CommunityChildren’sNurse,SouthWarwickshireNHSFoundationTrustDonnaPowell,LeadnurseforChildren’sContinuingCare,SouthWarwickshireNHSFoundationTrustLouiseBridges,ServiceManager,CYPComplexPhysicalHealthServicesChildandFamilyServices,CWPTAssociationofPaediatricChartedPhysiotherapist(APCP)respiratorycommittee:LaurenWilliams,AdvancedPhysiotherapist,SheffieldChildren’sHospitalSheonaStubbs,TeamLeadPaediatricPhysiotherapist,SerennuChildren'sCentre,NewportJoThornton,SpecialistPaediatricPhysiotherapist,BurnleyHospitalRachelEvans,IndependentPaediatricRespiratoryPhysiotherapistZoeJohnstone,ClinicalSpecialistRespiratoryPhysiotherapist,RHSCEdinburghAlliedHealthprofessionalsMidlandsLongTermVentilationNetwork:NickyMcNarry,RegionalLTVClinicalSpecialistPhysiotherapist,NottinghamChildren’sHospitalNicRutter,ContinuingCareTeamSpecialistPhysiotherapist,DerbyChildren’sHospitalDrMichelleChatwin,ConsultantPhysiotherapist,RoyalBromptonHospital.
Jagtar Singh OBE - Chair Simon Gilby - Chief Executive
Coventry & Warwickshire Partnership NHS Trust Wayside House, Wilsons Lane, Coventry, CV6 6NY
Tel: 024 7636 2100 Fax: 024 7636 8949 www.covwarkpt.nhs.uk
HFCWOReferences
1. AnbarRD(1998)CompliancewithuseofThAIRapyVestbypatientswithcysticfibrosis,PaediatricPulmonol1998(suppl17):346,A497
2. AnbarRD.(1999)UseofThAIRapy®Vestdoesnotaffectliverfunctionofpatientswithcysticfibrosis.AmJRespirCritCareMed;159(3),A687.
3. Appetal(1998)PhysiotherapyandmechanicalbreakdownoftheexcessiveDNAloadinCFsputum-ananti-inflammatorytherapeuticstrategy,PaediatricPulmonology,suppl17;349,A507.
4. ButlerS,O’NeillB(1995)Highfrequencychestcompressiontherapy:acasestudy.PediatrPulmonol;19:56-59.
5. Burnettetal(1993)Comparativeefficacyofmanualchestphysiotherapyandahighfrequencychestcompressionvestininpatienttreatmentofcysticfibrosis,AmRevRespirDis1993;(suppl147):A30
6. CastagninoM,VojtovaJ,KaminskiS,FinkR(1996)SafetyofHighFrequencyChestWallOscillationinpatientswithrespiratorymuscleweakness.Chest;110:S65.
7. ChiappettaA,BeckermanR(1995).HighFrequencyChestWallOscillationinspinalmuscularatrophy(SMA).RTJRespirCarePract;8(4):112-114.
8. GomezA,ElisanI,HardyK(2000)HighFrequencyChestWallOscillation:videodocumentationofeffectonapatientwithduchenne’smusculardystrophyandseverescoliosis.Posterpresentationatthe46thInternationalRespiratoryCongressoftheAmericanAssociationforRespiratoryCare,October7,Cincinnati,Ohio,USA.
9. Hansenetal(1990)Highfrequencychestcompressionsystemtoaidinclearanceofmucusfromthelung.BiomedInstrumTechnolo,24,pp289-294
10. Kluftetal(1996)AcomparisonofbronchialdrainagetreatmentsinCF,PaediatricPulmonol,Oct1996,22(4),p271-4
11. Ndukwuetal(1999)ComparisonofHFCWOandmanualchesttherapyinlongtermacutecarehospitalventilator-dependantpatients,Chest,116
12. OermannCMetal(2001)ComparisonofHFCWOandoscillatingPEPinhomemanagementofCF:apilotstudy,PaediatricPulmonolv32,no.5,Nov,p372-377
13. PiquetJ,BrochardL,IsabeyD,DeCremouxH,ChangHK,BignonJ,HarfA.(1987)Highfrequencychestwalloscillationinpatientswithchronicairwayobstruction,AmRevRespiratorydisease,136,pp1355-1359
14. PerryRJ,ManGCW,JonesRL(1998)Effectsofpositiveend-expiratorypressureonoscillatedflowrateduringhighfrequencychestcompression.Chest;113(4):1028-1033.
15. Robinsonetal(1992)Evaluationofahighfrequencychestcompressiondeviceincysticfibrosis,PaediatricPulmonol1992;(suppl8):304,A225
16. Whitmanetal(1993)Preliminaryevaluationofhighfrequencychestcompressionforsecretionclearanceinmechanicallyventilatedpatients.RespiratoryCare,38(10),pp1081-108
17. NICE:TheVestfordeliveringhigh-frequencychestwalloscillationinpeoplewithcomplexneurologicalneeds:Medtechinnovationbriefing(2018)
Jagtar Singh OBE - Chair Simon Gilby - Chief Executive
Coventry & Warwickshire Partnership NHS Trust Wayside House, Wilsons Lane, Coventry, CV6 6NY
Tel: 024 7636 2100 Fax: 024 7636 8949 www.covwarkpt.nhs.uk
MI-EReferences
18. Andersonetal.Systematicreviewoftechniquestoenhancepeakcoughflowandmaintainvitalcapacityinneuromusculardisease:thecaseformechanicalinsufflation-exsufflation.PhysicalTherapyReview2005;10:25-35
19. BachJR.Amyotrophiclateralsclerosis:prolongationoflifebynoninvasiverespiratoryAIDS.Chest.2002;122(1)92-8
20. Birnkrant(2018)DiagnosisandmanagementofDuchennemusculardystrophy,part2:respiratory,cardiac,bonehealth,andorthopaedicmanagement.LancetNeurology,vol17
21. BritishThoracicSocietyGuidelineforrespiratorymanagementofchildrenwithneuromuscularweakness;JeremyHull,RoonaAniapravan,ElaineChan,MichelleChatwin,JulianForton,JayneGallagher,NeilGibson,JillGordon,ImeldaHughes,ReneeMcCulloch,RobertRossRussell,AnitaSimonds,Thorax;July2012,vol27
22. BritishThoracicSociety/ACPRCguidelines;Physiotherapymanagementoftheadult,medicalspontaneouslybreathingpatientMay2009
23. ConsensusStatementonStandardofCareforCongenitalMuscularDystrophies(2010)JournalofChildNeurology25(12)1559-1581
24. CWPT:Community–ChildrenandYoungPeople:ClearwayMechanicalInsufflation-ExsufflationClinicalProcedure
25. Fauroux B, GuillemotN, AubertonG,NathanN, Labit A, Clement A, et al. Physiologic benefits ofmechanical insufflation-exsufflation in childrenwithneuromusculardiseases.Chest.2008;133(1):161-8.
26. Finkeletal(2018)Diagnosisandmanagementofspinalmuscularatrophy:Part2:Pulmonaryandacutecare;medications,supplementsandimmunizations;otherorgansystems;andethics.NeuromuscularDisorders28,197–207
27. GuerinC:BourdinG:LerayV;DelannoyB;BayleF;GermainM;RichardJC(2011)performanceofthecoughassistinsufflations-exsufflationdeviceinthepreseanceofanendotrachealtubeoftrachesotomytube:abenchstudy.RespiratoryCare;August;vol56,vol56,no.8.
28. Kravitz,R.(2009).AirwayclearanceinDuchenneMuscularDystrophy.Pediatrics,123(Suppl4)29. NHSEngland'sservicespecificationforneurosciences:specialisedneurology(adult)D04/S/a-Annex
Bincludeschildren201330. RespiratoryCareofthePatientwithDuchenneMuscularDystrophy:ATSconsensusStatement.AmJ
RespirCritCareMed.2004August15,2004:170(4)456-6531. ToussaintM(2011).Theusemechanicalinsufflations-exsufflationviaartificialairways.Respiratory
Care;August;vol56,No6.pp1217-9.32. Wang,Cetal(2007)ConsensusStatementforStandardofCareinSpinalMuscularAtrophy,Journal
ofChildNeurology,Volume22Number8,August20071027-104933. Winck,JC,Goncalves,MR,Lourenco,C,etalEffectsofmechanicalinsufflation-exsufflationon
respiratoryparametersforpatientswithchronicairwaysecretionencumbrance.Chest2004;126,774-780
34. Winck,JC,Goncalves,MR.Commentary:Exploringthepotentialofmechanicalinsufflation–exsufflationBreathe,June2008,Vol4,No4
35. Winfield,N.(2014).Non-pharmaceuticalmanagementofrespiratorymorbidityinchildrenwithsevereglobaldevelopmentaldelay.TheCochraneDatabaseofSystematicReviews
36. Chatwin,Metal(2018)Airwayclearancetechniquesinneuromusculardisorders:Astateoftheartreview,RespiratoryMedicine136,98-100
Jagtar Singh OBE - Chair Simon Gilby - Chief Executive
Coventry & Warwickshire Partnership NHS Trust Wayside House, Wilsons Lane, Coventry, CV6 6NY
Tel: 024 7636 2100 Fax: 024 7636 8949 www.covwarkpt.nhs.uk
Appendix(1)
Quotes(March2018)NippyClearwayBreasMedical(MI-Edevice):(excludingVAT)
• Costofequipment:£3300.00withstarterpack.• 1Yearsupplyofconsumables:Mask,Tubeandfilterboxof12for1year£160.00.Replace
monthly.Thismayvarydependingonlocalinfectioncontrolpolicy.• Rentalcosts:£190.00permonthincludesdeviceandconsumables.Minimum12weeks
rental.Nodailyrentaloption• Warranty:1year• Servicingoptions:Differentoptions.Bronzeservice(annualServicewithnoloandevice)
£150.00,Silver£500.00andGold£780.00.Maybeabletobeservicedlocally.• TrialLoanperiod:2monthsnocharge
E70CoughAssistPhilips(MI-Edevice):(excludingVAT)
• Costofequipment:£3,436.51or£3,702.91withbattery,circuitsx12andfilters• 1Yearsupplyofconsumables:circuit,interfaceandfilterperpack£16.64sox2£33.28per
year.Replace6monthly.Thismayvarydependingonlocalinfectioncontrolpolicy.• Rentalcosts:£380.00permonth• Warranty:1year• Servicingoptions:Differentoptions.Bronzeservice£255.00,Silver£340.00andGold
£298.00for1styear.Maybeabletobeservicedlocally.• TrialLoanperiod:1monthnocharge
TheVestHill-Rom(HFCWOdevice):(excludingVAT)
• Costofequipment:£6,995forunit(airpulsegenerator),hoses,twopermanentgarments,remote,manualandbluebag.
• 1Yearsupplyofconsumables:Permanentgarments(£275-295.00each)andhoses(£25.00set)shouldlast2-3years.
• Rentalcosts:£10.00perdaywithminimumrental3monthperiod• Warranty:2years• Servicingoptions:Fixedpricerepair£399.00.Differentoptionsfrom£245.00to£358.00
excludingVAT.Maybeabletobeservicedlocally.• TrialLoanperiod:3monthnocharge
FundingacrossUKTherearelargevariationsinhowequipmentisfundedacrossservicesinEngland,ScotlandandWales.ThismaydependonlocalCCGagreements.
• InScotlandandWales,donotapplyforfundingforequipmentsuchasventilatorsandcoughassist.Maybeprovidedbytertiarycentre.
• UHNMhaveaCCGfundingagreementforcoughassists
Jagtar Singh OBE - Chair Simon Gilby - Chief Executive
Coventry & Warwickshire Partnership NHS Trust Wayside House, Wilsons Lane, Coventry, CV6 6NY
Tel: 024 7636 2100 Fax: 024 7636 8949 www.covwarkpt.nhs.uk
Appendix2
AcharttoshowthecriteriaindicatedforusingHFCWOinCYPinCWPTandotherareasbetween
March2017andMay2018.
Atotalof6CYPwereusedinthissurvey.ThechartshowsthecriteriaindicatedforusingHFCWOineveryCYPwere:
• Chronicmucushypersecretionorsecretionretentionassociatedwithachronicpulmonaryorneuromuscularcondition
• OngoingfatiguedespitetheinitiationofNIV,lackofstrengthorabilitytoperformactiverespiratoryphysiotherapytreatment
• Highburdenofcare
0
1
2
3
4
5
6
7
Acutechestinfectio
nwith
secretion
retention
Chronicmucushypersecretionorse
cretion
retentionassociated
with
achron
ic
pulm
onaryorneu
romuscularcon
ditio
n
Alternativeairw
ayclearanceth
erapy
proven
ineffectiveorcon
traind
icated
Longte
rmven
tilated
with
evide
nceof
secretionretention
Ongoingfatig
uedespiteth
einitiationof
NIV,lackofstrengthora
bilitytoperform
activ
erespira
toryphysio
therapytreatm
ent
Symptom
atic
Prolon
gedabsencefrom
scho
oldue
to
chestinfectio
ns
Highburde
nofcare
NoofCYP
Jagtar Singh OBE - Chair Simon Gilby - Chief Executive
Coventry & Warwickshire Partnership NHS Trust Wayside House, Wilsons Lane, Coventry, CV6 6NY
Tel: 024 7636 2100 Fax: 024 7636 8949 www.covwarkpt.nhs.uk
AcharttoshowthetotalnumberofcriteriaindicatedforusingHFCWOinCYPinCWPTandotherareasbetweenMarch2017andMay2018.
EachcolumnrepresentsoneCYPinanarea.InCWPT,thereare3CYPwhorequiredHFCWOandthetotalnumberofcriteriaindicatedwasbetween5and8.ThedatawascollectedfromotherphysiotherapistsacrosstheUKworkinginacuteandcommunitysectors.Thetotalnumberofcriteriaindicatedfromotherareaswasbetween3and8.HFCWOisnotwidelyusedandsoitwasdecidedtousethedatafromCWPTas3CYPareusingtheHFCWO.IfaCYPinCWPTmeets5ormoreofthecriteria,HFCWOmaybeconsidered.ThisisonlyaguideandclinicalreasoningshouldbeappliedwhenselectingappropriateairwayclearancedevicesfortheCYP.
0
1
2
3
4
5
6
7
8
9
NUH CWPT CWPT CWPT RHSC Sheffield
Noofcriteria
Jagtar Singh OBE - Chair Simon Gilby - Chief Executive
Coventry & Warwickshire Partnership NHS Trust Wayside House, Wilsons Lane, Coventry, CV6 6NY
Tel: 024 7636 2100 Fax: 024 7636 8949 www.covwarkpt.nhs.uk
AcharttoshowthecriteriaindicatedforusingMIEinCYPinCWPTandotherareasbetweenMarch2017andMay2018.
Atotalof65CYPwereusedinthissurvey.ThechartshowsthecriteriaindicatedineveryCYPforusingtheMIEwas:
• IneffectivecoughorinabilitytoremovemucusbycoughingThenextmostcommoncriteriaindicatedforusingtheMIEwere:
• OngoingfatiguedespitetheinitiationofNIV,lackofstrengthorabilitytoperformactiverespiratoryphysiotherapytreatment
• Wherebreathstackingand/ormanualassistedcoughprovenineffectiveorcontraindicated• Highburdenofcare
0
10
20
30
40
50
60
70
Acutechestinfectio
nwith
secretion
retention
Chronicmucushypersecretionor
secretionretentionassociated
with
a
chronicpu
lmon
aryorneu
romuscular
cond
ition
Ineffectivecoughorinabilityto
remove
mucusbycoughing
Whe
rebreathstackingand
/orm
anual
assistedcoughproven
ineffectiveor
contraindicated
Longte
rmven
tilated
with
evide
nceof
secretionretention
Clinicalevide
nceofhyperinfla
tionand/
orairtrapping
Ongoingfatig
uedespiteth
einitiationof
NIV,lackofstrengthora
bilityto
performactiverespira
tory
physiotherapytreatm
ent
Symptom
atic
Prolon
gedabsencefrom
scho
oldue
to
chestinfectio
ns
Highburde
nofcare
NoofCYP
Jagtar Singh OBE - Chair Simon Gilby - Chief Executive
Coventry & Warwickshire Partnership NHS Trust Wayside House, Wilsons Lane, Coventry, CV6 6NY
Tel: 024 7636 2100 Fax: 024 7636 8949 www.covwarkpt.nhs.uk
AcharttoshowthetotalnumberofcriteriaindicatedforMIEinCYPinCWPTandotherareas
betweenMarch2017andMay2018.
InCWPT,thereare4CYPwhorequiredMI-Eandthetotalnumberofcriteriaindicatedwasbetween6and9.Thetotalnumberofcriteriafromotherareasvariedbetween3to9.MI-Eisamorecommonlyuseddeviceanddatashowedacrosstheareasonaverage,theminimumnumberofcriteriaindicatedforusingMI-Ewas5ormore.IfaCYPinCWPTmeets5ormoreofthecriteria,MI-Emaybeconsidered.ThisisonlyaguideandclinicalreasoningshouldbeappliedwhenselectingappropriateairwayclearancedevicesfortheCYP.NB:Sheffieldcriteria:TheonepatientwithsignificantlylowercriteriahadAtaxia-telangiectasia(AT)andadvisedtoprovideMI-EfromspecialistcentreduetoareducedPCFresult(asidentifiedinstandardsandseecriteriaabove).
0
1
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3
4
5
6
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8
9
10
NUH
NUH
NUH
NUH
NUH
NUH
NUH
NUH
NUH
NUH
NUH
NUH
NUH
NUH
CWPT
CWPT
Private
HH
HH
HH
HH
RHSC
RHSC
Sheffie
ld
Sheffie
ld
Sheffie
ld
Sheffie
ld
Sheffie
ld
Sheffie
ld
Noofcriteria
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