G502(P)\u2005Evaluation into the benefits of using high frequency chest wall oscillation (hfcwo -the vest) in children with complex care needs

Abstract

Children with complex disability often have difficulties with secretion clearance leading to recurrent lower respiratory tract infections (LRTIs) and prolonged admissions. High Frequency Chest Wall Oscillation (HFCWO – The Vest) dislodges mucous from the bronchial walls and mobilises secretions from smaller to larger airways where they can be cleared by coughing/suctioning. Its use remains selective due to its relative high cost. Our aim was to conduct a clinical evaluation to demonstrate the respiratory outcomes on a paediatric patient group and cost savings associated with admission using HFCWO compared to standard treatment of manual techniques, positioning and suction. A retrospective evaluation was completed on children with complex needs and a history of LRTIs. We captured quantitative and qualitative information via questionnaire and patient notes twelve months pre and post implementation of HFCWO. Eight children; three female and five male aged 6.5 to 18 years were eligible. Diagnoses included severe cerebral palsy (3), acquired brain injury (1), Pallister Killian syndrome (1), MCP2 duplication syndrome (1), Smith Lemli Opitz syndrome (1) and hydraencephaly (1). All children were functioning at the equivalent level to a cerebral palsy child Gross Motor Classification scale (GMFCS) level 5 i.e. total dependency for all needs. Table 1,Abstract G502(P) Table 1 Parameter Pre HFCWO Post HFCWO Difference Admissions 21 4 80.9%↓ Cost of admissions £66\u2009612 £9516 £57\u2009096 Bed Days 156 29 85.3%↓ LRTIs 37 21 43.2%↓ Antibiotics 35 19 45.7%↓ GP consultations 23 8 65.2%↓ There were nil adverse effects and the HFCWO was well tolerated. It delivered consistent and effective therapy resulting in improved patient outcomes. Parents and carers stated it reduced their burden of care, delivered therapy in a standardised way compared to manual techniques, alleviated their anxiety and improved the quality of life of their child and family as a whole. A significant cost saving was observed due to admission avoidance.