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
acapella® Vibratory PEP Therapy System
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
TheraPEP® PEP Therapy System
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
EzPAP® Continuous Positive Airway Pressure Therapy System
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
Coach 2® and CliniFLO® Incentive spirometry
An adjunct to deep breathing techniques • Can prevent atelectasis
acapella® Vibratory PEP Therapy System
Criteria Benefits of treatment Results
acapella® Vibratory PEP Therapy System
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
TheraPEP® PEP Therapy System
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
EzPAP® Continuous Positive Airway Pressure Therapy System
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
Coach 2® and CliniFLO® Incentive spirometry
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
Coach 2® and CliniFLO® Incentive spirometry
Criteria Benefits of treatment Results
acapella® Vibratory PEP 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
TheraPEP® PEP Therapy System
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
EzPAP® Continuous Positive Airway Pressure Therapy System
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
acapella® Vibratory PEP Therapy System
Criteria Benefits of treatment Results
acapella® Vibratory PEP 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
TheraPEP® PEP Therapy System
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
EzPAP® Continuous Positive Airway Pressure Therapy System
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
TheraPEP® PEP Therapy System EzPAP® Continuous Positive Airway Pressure Therapy System
Criteria Benefits of treatment Results
acapella® Vibratory PEP 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. 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
Air trapping associated with chronic secretions/hypersecretions
• 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
TheraPEP® PEP Therapy System
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
Necessity of multiple treatments
• 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
EzPAP® Continuous Positive Airway Pressure Therapy System
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
acapella® Vibratory PEP Therapy System
Criteria Benefits of treatment Results
acapella® Vibratory PEP 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. 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
Air trapping associated with chronic secretions/hypersecretions
• 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
TheraPEP® PEP Therapy System
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
Necessity of multiple treatments
• 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
EzPAP® Continuous Positive Airway Pressure Therapy System
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)
TheraPEP® PEP Therapy System EzPAP® Continuous Positive Airway Pressure Therapy System
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
Required patient expiratory flow rate 15 L / min
Required patient expiratory flow rate 15 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
Part number Description Units/case
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
Part number Description Units/case
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