These devices differ substantially in design as well as in performance. Many devices are available to provide PEP and oscillating PEP treatment. There are similarities and differences among all of the devices, and the equipment components are not interchangeable without changing the achieved PEP levels. For some devices, the device's position also has an impact on the outcome. Oscillation frequency in oscillating PEP devices affects the pressure and oscillation amplitude and flow. The achieved PEP is dependent on the given resistance or achieved expiratory flow through the devices and their separate parts. The literature search resulted in 812 studies, which, after being read by 2 independent reviewers, were reduced to 21 trials that matched the inclusion criteria. The literature search was performed in PubMed, CINAHL, Cochrane Library, Embase and PEDro. In this systematic review, we included trials evaluating different technical aspects of devices and equipment for PEP and oscillating PEP until June 2019. The aims of this review were to describe and compare technical aspects of devices and equipment used for PEP and oscillating PEP as a basis for clinical decisions regarding prescriptions. There is a lack of evaluation concerning technical aspects and construction of the devices. There are several trials evaluating the clinical effects of a variety of commercially available and self-made devices. Acapella's performance is not gravity-dependent (ie, dependent on device orientation) and may be easier to use for some patients, particularly at low expiratory flows.īreathing exercises with positive expiratory pressure (PEP) and oscillating PEP are common treatments for patients with respiratory impairments. At 5 L/min the Acapella produced a more stable waveform, with a lower frequency, higher amplitude, and a slightly wider range of PEP than the Flutter.Īcapella and Flutter have similar performance characteristics. Both devices produced similar pressure waveforms at the medium flows. However, the differences were relatively small and may not be clinically important. There were statistically significant differences between the devices for mean pressure, pressure amplitude, and frequency, for all experimental conditions. Data were analyzed by 2-way repeated measures analysis of variance, and differences were considered significant when p was < 0.05. The devices were adjusted to give low, medium, and high mean expiratory pressure (Flutter angle at 0, 20, and 40 degrees Acapella by dial setting). The pressure waveform for 1 second was also graphically displayed and recorded. Values for frequency, peak, trough, and mean pressure were recorded automatically every 3 seconds at flows of 5, 10, 15, 20, 25, and 30 L/min. We measured oscillatory amplitude, PEP, and frequency. We hypothesized that the Acapella and Flutter would produce similar mean PEP, oscillatory pressure amplitude, and frequency over a clinically relevant range of flows. The Acapella comes in 2 models: one for patients with expiratory flow > or = 15 L/min and one for < or = 15 L/min. A new device, the Acapella, uses a counterweighted plug and magnet to create air flow oscillation. In the Flutter a steel ball vibrates inside a cone, causing air flow vibration. Plus, it can be used with your mask or mouthpiece nebulizer.Oscillatory positive expiratory pressure (PEP) with the Flutter device facilitates secretion removal. The Acapella Valve is designed to be easily cleaned and sterilized. This should take between 10 and 20 minutes. Repeat until no further mucus is expelled. After 5 or 6 exhalations try to cough if you have not done so already. At the end of each exhalation, hold your breath 2 to 3 seconds. Keep alternating between regular and slow breathes. Your exhalations should be about 3 times longer than your inhalations. Breathe in and out regularly through the valve 5 times. If your lungs are lower volume, you can use the blue or low flow valve. The green or high flow valve is for users who can exhale at 15 liters per minute or more for at least three seconds. Exhaling against resistance creates back pressure or positive pressure which allows mucus to move from peripheral airways to the larger central airways so it can be coughed out. Why’s that good? The vibration opens up your airways, facilitating the movement of mucus. As you exhale, the ball moves up and down, doing two things-a) vibrating your airways and b) making you exhale against resistance. How’s it work? Inside the valve is a small steel ball in a cone shaped valve. It combines the benefits of positive expiratory pressure or PEP therapy with airway vibrations. The Acapella Valve is a unique handheld device that keeps your lungs clear of mucus so you can breathe easy.
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