Effects of High-Frequency Chest Wall Oscillation on Acute Exacerbation of Chronic Obstructive Pulmonary Disease: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Figures & data

Figure 1 PRISMA flow diagram of included studies.

Notes: Adapted from Moher D, Liberati A, Tetzlaff J, Altman DG, The PRISMA Group (2009). Preferred Reporting Items for Systematic Reviews and Meta-Analyses: The PRISMA Statement. PLoS Med 6(7): e1000097. Creative Commons.⁶

Table 1 Characteristics of Included Studies

First Author, Year	Subject	Average Age (Years)	Treatment Group	N	Treatment Setting F, Frequency; P, Pressure	Duration
Chakravorty, 2011^Citation10	AECOPD GOLD 2 or 3	71	HFCWO	11	F: 13~15 Hz; P: NR 20 min/time; 2 times/day	4 weeks
			Conventional therapy	11	Followed their own COPD management regimen	4 weeks
Duan, 2019^Citation15	AECOPD	70.3	HFCWO	43	F: NR; P: NR 15~20 min/time; 2 times/day	7 days
		69.7	Mechanical percussion	43	F: 12~15 Hz 15~20 min/time; 2 times/day	7 days
Goktalay, 2013^Citation9	AECOPD, GOLD 3 or 4	63.6	HFCWO	25	F: 10 Hz; P: NR 20 min/time; 3 times/day	5 days
		66.5	Conventional therapy	25	Followed their own COPD management regimen	5 days
Huang, 2013^Citation17	COPD and pulmonary infection with endotracheal or tracheostomy tube	65	HFCWO	30	F: 8 Hz; P: 5 units 10~15 min/time; 2 times/day	3 days
		71	Mechanical percussion	30	F: 10 Hz 10~15 min/time; 2 times/day	3 days
Li, 2017^Citation14	AECOPD, CAP Chronic bronchitis	78.7	HFCWO	15	F: 25 Hz; P: NR 10 min/time; 2 times/day	14 days
		84.9	Mechanical percussion	15	F: 25~35 Hz 10 min/time; 2 times/day	14 days
Li, 2020^Citation19	AECOPD	69.9	HFCWO and Conventional therapy	38	F: 6~15 Hz; P: 8~12 units 15~30 min/time; 3 times/day	NR
		68.5	Conventional therapy	32	Aerosol inhalation of an acetylcysteine solution 3 mL/time; 3 times/day	NR
Liu, 2014^Citation11	AECOPD with mechanical ventilation	76	HFCWO	17	F: 10~15 Hz; P: 2~4 units 15 min/time; 3 times/day	7 days
		77	Conventional therapy	18	Followed their own COPD management regimen	7 days
Mahajan, 2011^Citation12	Acute COPD, acute asthma and COPD	46.5	HFCWO	25	F: 10~12 Hz; P: 4~6 units 15 min/time; 3 times/day	2 days
		50.4	Sham HFCWO	27	F: NR; P: NR 15 min/time; 3 times/day	2 days
Ouyang, 2020^Citation20	AECOPD	65.3	HFCWO	38	F: 8~15 Hz; P: 4~6 kPa 15~30 min/time; NR	NR
		65.7	Conventional therapy	36	–	NR
Tan, 2020^Citation13	AECOPD GOLD 3 or 4	70.3	HFCWO	33	F: 10~14 Hz; P: 3~4 units 15 min/time; 3 times/day	5 days
		70.7	OPEP	36	P: 1-According to the patient’s tolerance 15 times/session; 3 sessions/day	5 days
Wang, 2021^Citation18	AECOPD	61.0	HFCWO	42	F: NR; P: NR 15 min/time; 3 times/day	5 days
		60.6	Conventional therapy	42	Postural drainage 15 min/time; 3 times/day	5 days
Xie, 2017^Citation16	COPD accompanied by pulmonary infection	58.6	HFCWO	40	F: 8 Hz; P: 5 units 10~15 min/time; 2 times/day	3 days
		58.5	Mechanical percussion	40	F: 10 Hz 10~15 min/time; 2 times/day	3 days
Zhang, 2019^Citation21	AECOPD	65.9	HFCWO	24	F: 8~15 Hz; P: 4~6 kPa 15~30 min/time; 1 time/day	14 days
		65.7	Conventional therapy	20	-	14 days

Abbreviations: AECOPD, acute exacerbation of COPD; COPD, chronic obstructive pulmonary disease; GOLD, Global Initiative for Chronic Obstructive Pulmonary Disease; HFCWO, high-frequency chest wall oscillation; NR, not recorded; OPEP, oscillating positive expiratory pressure.

Figure 2 Quality assessment of bias using Cochrane Collaboration 2.0.

Figure 3 Forest plot of HFCWO vs control group treatment time, outcome: Sputum expectoration.

Figure 4 Forest plot of HFCWO vs mechanical vibration, conventional, and OPEP, outcome: Sputum expectoration (mL).

Figure 5 Forest plot of HFCWO versus control group, outcome: Hospital stay (days).

Figure 6 Forest plot of HFCWO versus control group, outcome: FEV₁ (%).

Figure 7 Forest plot of HFCWO versus control group, outcome: ABGs (A) PaO₂ (mmHg) (B) PaCO₂ (mmHg) (C) SpO₂ (%).

Figure 8 Forest plot of HFCWO versus control group, outcome: Dyspnea assessment.

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