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Comparison of high frequency chest compression (HFCC) with hypertonic saline for the induction of sputum.
Rhame F; Armstrong J; Beneke J; McComb C; Klous D; Sadowski P; Dept of
December 30, 1992
Int Conf AIDS. 1992 Jul 19-24;8(3):51 (abstract no. PuB 7017). Unique

OBJECTIVES: We hypothesized that HFCC, which improves mobilization of sputum in cystic fibrous patients, would be a non-invasive but sensitive method of sputum induction for the diagnosis of pneumocystosis and other pulmonary infections in HIV infected persons. Our primary focus in this pilot study was to compare pulmonary alveolar macrophage recovery by HFCC and by hypertonic saline. METHODS: Nine HIV infected, clinically stable subjects with CD4 counts less than 200 were recruited. Exclusion criteria included chest tubes, asthma, or a recent history of hemoptysis, pneumothorax, thoracotomy, or central line placement. Inductions were 48 hr apart in random order. Saline induction (SI) used 20-30ml 3% saline by ultrasonic nebulizer. HFCC used the ThAIRapy System vest at 18, 14 and 7 Hz, each x 10min. Subjects were assessed for comfort level, O2 saturation, pulse and peak expiratory flow (PEF) before, during, and after the inductions. Sputum was assessed by persons blinded to the induction method. Direct smears and smears of sedimented cells after dithiolthreitol solubilization were stained with Papanicolaou and Pneumocystis stains. Salivary (squamous) cells plus 400 pulmonary (bronchial epithelial, alveolar macrophages, and PMN/lymph/eos) cells were counted. RESULTS: Two subjects experienced nausea during HFCC (one had prior nausea and did not complete the induction). One patient could not produce sputum. For the 7 subjects producing paired specimens, there was no difference in delta comfort level from baseline, delta O2 saturation, delta PEF between the two induction procedures. The mean volumes of specimens were HFCC 3.5ml, SI 4.0ml. The mean ratio of salivary to pulmonary cells was comparable (direct: HFCC 2.1, SI 4.8; solubilized: HFCC 1.8, SI 4.0). The % of pulmonary cells which were macrophages was also similar (direct: HFCC 10.4, SI 7.9 (P NS); solubilized: HFCC 7.9, SI 16.9, p, paired t = .02). Pneumocystis organisms were not seen. CONCLUSION: 2/9 patients experienced nausea during HFCC but it was otherwise well tolerated. Sputum induction by HFCC and SI produced similar specimens as measured by the fraction of cells which were pulmonary and the fraction of pulmonary cells which were alveolar macrophages. Alveolar macrophage recovery was substantial. The relative diagnostic sensitivity for Pneumocystis requires direct assessment.

Cell Count Comparative Study Human HIV Infections/*COMPLICATIONS Macrophages, Alveolar/PATHOLOGY Pneumonia, Pneumocystis carinii/COMPLICATIONS/*DIAGNOSIS Respiratory Therapy/INSTRUMENTATION Saline Solution, Hypertonic/ADMINISTRATION & DOSAGE Sensitivity and Specificity Specimen Handling/*METHODS Sputum/*CYTOLOGY ABSTRACT