Clinical indications for HFCWO

The decision of when it’s medically appropriate to prescribe high frequency chest wall oscillation (HFCWO) rests squarely in the hands of physicians and their patients, based on each patient’s particular health condition and response to other treatments.

HFCWO is clinically proven to be effective for airway clearance. The diseases and conditions listed here are among those that can impair airway clearance, and for which HFCWO has been prescribed by physicians and reimbursed by insurance providers.

Prescribing HFCWO

Indications for when HFCWO can and should be prescribed are not specific to any one disease. A physician may elect to prescribe HFCWO when he or she believes:

  • The patient will benefit from improved airway clearance
  • External chest manipulation is the treatment of choice to enhance mucus transport and improve bronchial drainage

According to American Association for Respiratory Care (AARC) clinical practice guidelines, indications for external chest manipulation techniques such as HFCWO include:

  • Evidence of excess pulmonary secretions
  • History of respiratory infections
  • At least 2 hospitalizations due to pulmonary exacerbation
  • Emergency-room visits due to pulmonary exacerbation
  • 3 exacerbations requiring antibiotics
  • Intravenous antibiotics
  • Oral antibiotics
  • Daily productive cough for at least 6 months
  • Mucus plugging
  • Atelectasis
  • Sputum tested positive for resistant bacteria
  • Decline in pulmonary function

AARC guidelines also note that manual chest physiotherapy (CPT) might not be an option for treating impaired airway clearance if the patient has no caregiver, cannot tolerate the Trendelenburg position, or is fragile and cannot tolerate CPT. In these cases, HFCWO might be an effective alternative treatment to CPT.

HFCWO contraindications

Absolute contraindications for external chest manipulation techniques such as HFCWO, as identified by AARC guidelines, include patients with:

  • Head and neck injury
  • Active hemorrhage with hemodynamic instability

Relative contraindications for all types of external chest manipulation techniques such as HFCWO are also defined by the AARC guidelines. In all cases, relative contraindications should be assessed individually, based on each patient’s clinical condition. For additional information, clinicians should refer to AARC Clinical Practice Guideline: Postural Drainage Therapy.