High-Frequency Chest Wall Oscillation in Acute Respiratory Failure With Bronchial Hypersecretion: A Randomized Controlled Trial
In brief
Chest-wall oscillation patients stayed 4.5 fewer days in an exploratory trial
Among 88 patients with acute respiratory failure, bronchial secretions and weak cough, those given chest-wall oscillation had an adjusted hospital stay 4.5 days shorter and spent less time on high-flow oxygen. The treatment did not significantly reduce bronchoscopy after adjustment; the stay reductions are exploratory and need confirmation in larger, multicenter trials.
- Journal
- Chest (Q1)
- Published
- 14 October 2026
- Study design
- Randomized controlled trial
- Evidence level
- Level 1, High (CEBM 1b)
- Authors
- Simone Ielo, Nicoletta Golfi, Luca Guidelli, Stefania Arniani, Matilde Vespi, Gabriella Tacconelli, et al.
- PMID
- 42874912
- DOI
- 10.1016/j.chest.2026.10.007
Why clinicians should know about it
- Picked for Critical Care and Intensive Care Medicine (top studies of the week, 18 October 2026): High‑frequency chest wall oscillation lowered bronchoscopy need and ICU length
- Picked for Pulmonary and Respiratory Medicine (top studies of the week, 18 October 2026): HFCWO reduced bronchoscopy need, LOS
Abstract
BACKGROUND: Airway secretion retention is common in patients with acute respiratory failure (ARF), particularly in those requiring noninvasive respiratory support (NIRS). High-frequency chest wall oscillation (HFCWO) may improve airway clearance but critical care evidence remains limited. RESEARCH QUESTION: Does adding HFCWO to standard care improve clinical outcomes in patients with bronchial hypersecretion and ARF requiring NIRS? STUDY DESIGN AND METHODS: We conducted a single-center randomized controlled trial in a RICU. Patients with ARF requiring NIRS, including high-flow nasal cannula (HFNC) and/or noninvasive ventilation (NIV), bronchial hypersecretion, and ineffective cough (peak cough expiratory flow <270 L/min) were randomized 1:1 to HFCWO plus standard care or standard care alone. The primary endpoint was therapeutic bronchoscopy. Secondary endpoints included hospital length of stay (LOS), RICU-LOS, NIRS duration, endotracheal intubation and mortality. Outcomes were analyzed using unadjusted and adjusted models accounting for age, sex, and main cause of hospitalization. RESULTS: Eighty-eight patients were enrolled (44 HFCWO, 44 control), with comparable baseline characteristics. Bronchoscopy was required in 6 patients (13.6%) versus 14 (31.8%) (unadjusted p=0.042); after adjustment the association did not retain statistical significance (adjusted OR 0.336, 95% CI 0.111-1.021; p=0.055). Secondary outcomes, analyzed without correction for multiple testing, are exploratory. Hospital stay (12 [10-15.5] vs 16.5 [13-21] days) and RICU stay (8 [7-10.5] vs 12 [9-17] days) were shorter, with adjusted reductions of 4.5 and 3.6 days. HFNC duration was shorter (6 [4-8] vs 9.5 [6-11.5] days) and remained significant after adjustment, whereas the reduction in NIV duration did not (adjusted p=0.166). No patient required intubation and mortality did not differ. INTERPRETATION: In this exploratory trial, HFCWO did not significantly reduce the need for therapeutic bronchoscopy after adjustment. Associated reductions in LOS and HFNC duration are hypothesis-generating and require confirmation in adequately powered multicenter trials. CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov: NCT05751707; Tuscany Ethics Committee (Protocol: 21987-10/17/2022).
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.