Specialist commentator comments

Comments on this technology were invited from clinical specialists working in the field and relevant patient organisations. The comments received are individual opinions and do not represent NICE's view.

All 10 specialists were familiar with this technology and 9 had used or were currently using it in adults or children with complex neurological needs, neuromuscular disease, motor neurone disease or cystic fibrosis.

Level of innovation

Seven specialists noted that The Vest was the only device for high-frequency chest wall oscillation (HFCWO) available in the UK. Three specialists said that it was innovative because it standardised treatment (force, rate, time). One specialist explained there is always human variation with manual techniques. One specialist stated that devices such as The Vest were not new but that there has been very little reporting on their use in the UK.

Potential patient impact

Four specialists thought that using The Vest would give users more autonomy. They would not need to be as dependent on their carers or on clinicians. Two specialists thought that using The Vest may improve quality of life. Three noted that The Vest would offer a more standardised therapy than manual therapy.

Two specialists stated that The Vest can be administered sitting upright or lying down, which can reduce disruption and physical burden for both patients and carers, particularly if the patient is physically impaired or immobile.

One specialist noted that chest wall oscillation can be done at a higher frequency and for a longer time than a carer can do manual percussion. A specialist noted that the frequency of sessions might be reduced if The Vest is more effective.

One specialist said that The Vest may not be suitable in people with osteoarthritis or others who are at risk of fractures, in people who have spinal deformities or pressure damage, and it may have an effect on pacemakers or other monitoring devices. Another specialist commented that the risk compared with the benefit should be considered before starting treatment with The Vest for people with rib fractures, poor bone density or surgical sites or lines that would be affected by the position of The Vest on the chest wall.

One specialist highlighted that HFCWO is a technique to help mobilisation of secretions and still needs an effective cough to clear secretions. If a person has an ineffective cough effort, The Vest would have to be used with assisted cough techniques and suction to clear the secretions.

The specialists identified specific patient populations needing airway clearance who could benefit from The Vest:

  • People who are physically impaired or immobile, for example, people who may need to be lifted onto a bed for manual airway clearance.

  • People with learning disabilities who are unable to follow instructions for other chest clearance strategies.

  • People with low bone density in whom manual airway clearance techniques are unsuitable.

  • People who have not had successful airway clearance despite treatment, particularly those with frequent hospital admissions because of chest infections.

Potential system impact

One specialist who has used The Vest in children with complex neurological needs stated that it led to reduced chest infections in children who were frequently admitted to hospital for up to 2 weeks. This resulted in reduced antibiotic use, fewer hospital admissions and shortened length of stay, less invasive suctioning and less time off from school.

Several specialists thought that using The Vest could potentially lead to fewer chest infections or other respiratory illness, reduced antibiotic use and fewer hospital admissions. If it did lead to these reductions, then it would likely be cost saving to the NHS. One specialist said that The Vest could pay for itself if it prevented 1 hospital admission. Three other specialists stated that adopting The Vest is likely to lead to reduced overall costs but there would be a higher upfront cost to the NHS than current treatment. Three specialists stated that there was not currently enough published evidence comparing The Vest with chest wall physiotherapy to support any claims of system benefit.

Two specialists advised that it was easier to train carers in the use of The Vest than to train them to do manual chest wall physiotherapy techniques.

One specialist noted that it would be helpful to have another option for airway clearance available for people that had exhausted all other options.

General comments

One specialist noted that it can be difficult to get approval for funding of The Vest and that if further studies were done in the UK, an improved evidence base would help support future applications. One specialist advised that there is no locking mechanism on The Vest to prevent the settings from being adjusted accidentally.