Investigating the Effectiveness of Combining High-Frequency Chest Wall Oscillation with Intermittent Positive Pressure Breathing in Pneumonia Patients: A Retrospective Cohort Study Running head: Effectiveness of Combination of HFCWO and IPPB in Pneumonia

Investigating the Effectiveness of Combining High-Frequency Chest Wall Oscillation with Intermittent Positive Pressure Breathing in Pneumonia Patients: A Retrospective Cohort Study Running head: Effectiveness of Combination of HFCWO and IPPB in Pneumonia | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Investigating the Effectiveness of Combining High-Frequency Chest Wall Oscillation with Intermittent Positive Pressure Breathing in Pneumonia Patients: A Retrospective Cohort Study Running head: Effectiveness of Combination of HFCWO and IPPB in Pneumonia Ta-Wei Chao, Ya-Chen Kao, Hui-Ling Liu, Sheng-Hsiang Lin, Chin-Wei Kuo This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4730848/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 03 May, 2025 Read the published version in BMC Pulmonary Medicine → Version 1 posted 4 You are reading this latest preprint version Abstract Background: Pneumonia represents a significant global health burden with high morbidity and mortality rates, despite advances in therapeutic and preventive strategies. Airway clearance techniques (ACT), including High-Frequency Chest Wall Oscillation (HFCWO) and Intermittent Positive Pressure Breathing (IPPB), are critical in managing respiratory conditions. However, the combined effectiveness of IPPB and HFCWO in treating adult pneumonia remains underexplored. Methods: A retrospective cohort study was conducted at a college hospital in southern Taiwan, enrolling patients aged ≥ 18 years, admitted for pneumonia from January 2020 to December 2022, who received HFCWO therapy for ≥ 5 days in the ordinary ward. Exclusion criteria included prior mechanical ventilation before HFCWO initiation. Univariate and multivariable logistic regression models were used to assess the effectiveness of the combined use of IPPB and HFCWO. Results: A total of 271 patients received HFCWO and were enrolled for analysis, including 163 patients who received both IPPB and HFCWO. Patients receiving both IPPB and HFCWO were associated with shortened total hospital stays (OR: 0.49, 95% CI: 0.28–0.83, P = 0.008), decreased frequency of sputum suction (OR: 2.91, 95% CI: 1.46–5.78, P = 0.002), and reduced oxygen need post-HFCWO (OR: 0.55, 95% CI: 0.33–0.91, P = 0.021). However, there was no difference in hospital stay post-HFCWO use, respiratory failure, ICU admission, or hospital death between the groups. Additionally, there was no difference in these outcomes for patients who received HFCWO twice daily compared to those who received it once daily. Conclusions: Combining IPPB and HFCWO reduces the need for sputum suction and improves oxygen demand for patients but does not change hospital days, respiratory failure, or mortality. Further large prospective cohort studies are necessary to confirm the efficacy of this management approach. Pneumonia high-frequency chest wall oscillation intermittent positive pressure breathing hospital days Figures Figure 1 Figure 2 Introduction Pneumonia is a prevalent disease influenced by geography, season, and population characteristics. The estimated worldwide incidence of community-acquired pneumonia varies between 1.5 to 14 cases per 1000 person-years (1). Despite the development of numerous preventive and therapeutic management strategies, pneumonia remains a significant public health concern and a leading cause of mortality and morbidity worldwide (2, 3). For adult pneumonia, the mortality rate remains high, reaching up to 23% for patients admitted to the intensive care unit (1). The expenditures averaged of community-acquired pneumonia related hospitalization is 33,380 USD and the long-term phase averaged 83,463 USD (4). Even though antibiotics are the primary treatment for pneumonia, the high incidence and mortality rates, along with the increasing medical costs, continue to pose a significant burden on patients. On the other hands, supportive therapies, such as oxygen therapy and chest physiotherapy (CPT), have been proven effective and widely used (5). Airway clearance techniques (ACT) are among the most important components of CPT. They refer to a variety of different strategies used to eliminate excess secretions, reduce airway obstruction, ameliorate pulmonary atelectasis, and prevent respiratory tract infections that can lead to respiratory failure when an endotracheal tube is intubated (6). In recent years, there has been a focus on implementing ACTs for specific populations, including individuals with conditions such as bronchiectasis, cystic fibrosis (CF), and neuromuscular disease (NMD). In these groups, abnormal respiratory tract structures, changes in mucus characteristics, and muscle weakness contribute to impaired cough function, leading to the inability to effectively clear mucus (7). High-frequency chest wall oscillation (HFCWO) is a widely used strategy for secretion clearance. It involves the use of an inflatable vest connected to tubes connected to a compressor that can generate rapid inflation and deflation of the vest, producing oscillations that move mucus from the chest wall to the lungs (6, 8). HFCWO creates oscillations with a frequency of 5–25 Hz and pulse pressure settings ranging from 1–5 cmH2O, which are transmitted through the chest wall to the entire bronchial tree. Several studies have mentioned that HFCWO therapy is as effective as or superior to other ACTs in acute exacerbation patients with CF (9–12). The potential benefits of HFCWO therapy have also been reported in systematic reviews or clinical trials for chronic obstructive pulmonary disease (COPD), bronchiectasis, and neuromuscular disease (13–15). Although CPT is not traditionally recommended for the treatment of uncomplicated pneumonia, (16) new clinical evidence suggested that combining HFCWO with other treatments may offer additional benefits. For instance, Shi et al. demonstrated that HFCWO, when combined with bronchoscopic alveolar lavage (BAL), can reduce the mean duration of ICU stays and the use of mechanical ventilation in pneumonia patients, compared to BAL alone (5). Intermittent positive pressure breathing (IPPB) provides lung expansion through short-term, intermittent mechanical ventilation, and it can also deliver aerosol medication or assist in ventilation. IPPB includes pressure and time-limited ventilation, as well as pressure, time, and flow-cycled ventilation, which can be administered to both patients with artificial airways and those who are not intubated (16). Combining IPPB and HFCWO can simultaneously enhance patient lung ventilation and mucus clearance, achieving an additive effect. However, the clinical effectiveness of combining HFCWO with IPPB in adult pneumonia patients remains unclear. To investigate the clinical effectiveness of combination of IPPB and HFCWO for pneumonia treatment, we hypothesized that patients who receive the combination of IPPB and HFCWO treatment would demonstrate superior clinical outcomes compared to those who receive either one of these treatments individually or receive no additional treatment. To prove the hypothesis, we conducted a retrospective cohort study utilizing a pneumonia cohort at a college hospital in southern Taiwan to investigate the treatment effectiveness of the combined use of IPPB and HFCWO for patients with pneumonia. Methods Patient Enrollment and Study Design This study was conducted at National Cheng Kung University Hospital (NCKUH), a college hospital serving a population of 1.86 million inhabitants in Tainan City, Taiwan, as of 2022. The Institutional Review Board of NCKUH approved this study before its commencement (Approval Number: A-ER-112-261). Informed consent was waived due to the retrospective study design. Patients aged ≥ 18 years old, admitted to NCKUH for pneumonia between January 1, 2020, and December 31, 2022, and receiving HFCWO therapy were enrolled. Patients were excluded if they were 1) received HFCWO for less than 5 days, 2) received HFCWO in the ICU, 3) long-term mechanical ventilation dependence. For patients who received multiple HFCWO therapy sessions during their hospitalization, only the first HFCWO therapy session was included into the analysis. To prevent repeated measurements, we only analyzed the first admission for patients with multiple admissions for pneumonia during the study period. Data Collection, and the definition of variables and outcomes Patient information, including age, sex, body mass index (BMI), smoking status, comorbidities, oxygen usage, frequency of sputum suction, frequency and duration of HFCWO, the use of IPPB, chest X-ray (CXR) results, hospitalization duration, mechanical ventilation usage, admission to the ICU, and hospital mortality, was extracted from electronic medical records in the NCKUH database. Patients received non-invasive ventilation (NIV), invasive mechanical ventilation (IMV) or dead of pneumonia were defined as respiratory failure. The frequency of sputum suction indicates the average number of suction times during the 3 days before and after the completion of HFCWO therapy. Additionally, oxygen usage refers to the highest-intensity oxygen delivery device used during the 3 days before and after the completion of HFCWO therapy. The definition of post-HFCWO use hospital days is the interval between the last day of HFCWO use and the discharge day. Pneumonia severity was assessed using the Severe Acute Respiratory Infection (SARI) CXR severity scoring system, a validated five-point CXR scoring tool that demonstrates good agreement among clinicians with varying levels of experience. (17) In brief, the SARI scoring system categorizes patients into five levels based on CXR findings. Patients with normal findings, patchy atelectasis and/or hyperinflation and/or bronchial wall thickening, focal consolidation, multifocal consolidation, and diffuse alveolar changes are classified as scores 1 to 5, respectively. (Fig. 1 ) In this study, the SARI score was initially calculated by an internal medicine doctor and subsequently verified by a pulmonologist. The indication and setting of HFCWO and IPPB The indications for High-Frequency Chest Wall Oscillation (HFCWO) in pneumonia patients at NCKUH include poor airway clearance function, acute phase of COPD, CF, and bronchiectasis induced high sputum volume, and pulmonary atelectasis. Contraindications for HFCWO include unstable hemodynamic, massive hemoptysis, increase intracranial pressure (IICP), rib fracture, chest wall injury, and recent chest surgery. IPPB is routinely added for patients receiving HFCWO, except for those at risk of pneumothorax (e.g., large bullae, history of pneumothorax, or recent chest surgery or biopsy), unable to cooperate with IPPB, IICP, or with facial trauma or deformity. All applications of HFCWO and IPPB at NCKUH require approval from a pulmonologist and respiratory therapist following a comprehensive patient evaluation. The medical device for HFCWO is COMFORTCOUGH® II (Seoil Pacific Corp., South Korea). We configure the HFCWO device to "percussor" mode, setting the amplitude and frequency of percussion pressure based on patient comfort and clinical effectiveness. The amplitude of pressure was adjusted from 40 to 60 cmH 2 O and the frequency from 400 to 600 Hz, once or twice daily dependent on the availability of devices and respiratory therapists. The IPPB device used is FlexoTM Bi-Level, set to "S/T" mode. The settings for inspiratory positive airway pressure (IPAP) and expiratory positive airway pressure (EPAP) are 8–15 cmH 2 O and 6–8 cmH 2 O, respectively. These settings aim to achieve a lung volume expansion targeted at 1.5 times the predicted tidal volume, which is calculated based on the predicted body weight (8–10 ml/kg of predicted body weight). The respiratory rate was set at 10–12 breaths per minute, with the inspiratory time set at approximately 33% of the single breathing cycle. Each setting was adjusted based on clinical effectiveness and patient comfort. Statistical Analysis The collected data were presented as numbers (percentages), means (standard deviations), or medians (interquartile range [IQR]) depending on the nature of the data. Independent t-tests and Mann-Whitney U tests were utilized to analyze continuous variables with or without a normal distribution, respectively. Fisher’s exact test was employed to analyze categorical variables. Univariable and multivariable logistic regression analyses were conducted to investigate the effectiveness of IPPB and HFCWO. Multivariate model adjusted the covariates including the group of IPPB use and other covariates selected in the univariate model with p-values less than 0.1. Associations were established using odds ratios (ORs) and 95% confidence intervals (CIs). All P-values were calculated as two-sided, and a P < 0.05 was considered statistically significant. All statistical analyses were carried out using SAS software (version 9.4; SAS Institute, Cary, NC, USA). Results Between January 1, 2020, and December 31, 2022, a total of 863 patients at NCKUH received HFCWO for pneumonia. After excluding patients with repeated admissions for pneumonia (n = 186), those treated in the ICU (n = 208), and those who received HFCWO for less than 5 days (n = 198), 271 patients were eligible for analysis ( Fig. 2 ) . Among these patients, 163 received a combination of IPPB and HFCWO for pneumonia, while 108 received HFCWO alone ( Table 1 ) . Compared to patients who received HFCWO alone, those who received both IPPB and HFCWO were older, need lower oxygen support level and required more frequent sputum suctioning. There was no difference between the two groups in sex, BMI, smoking status, comorbidities, baseline SARI CXR scores, the number of HFCWO days, or the frequency of HFCWO use. Table 1 Basic demographic information and clinical outcomes of enrolled patients who received HFCWO treatment No IPPB use (N = 108) IPPB use (N = 163) N or median (%) or IQR N or median (%) or IQR P-value * Basic information Age, median (IQR)(year) 78.5 (70, 85.5) 83 (74, 89) 0.008 Male, n (%) 78 72.22 116 71.17 0.959 BMI level, n (%) 0.290 Underweight 30 27.8 47 28.8 Normal 63 58.3 103 63.2 Overweight 15 13.9 13 8.0 Active smoking, n (%) 16 14.8 16 9.8 0.291 Comorbidities, n (%) COPD 19 17.6 27 16.6 0.956 Bronchiectasis 11 10.2 11 6.8 0.431 Pulmonary fibrosis 2 1.9 6 3.7 0.483 † CVA 30 27.8 43 26.4 0.909 Heart failure 19 17.6 39. 23.9 0.274 CKD 30 27.8 49 30.1 0.788 Baseline clinical severity Oxygen demand, n (%) < 0.001 Room air or N/C 36 33.3 85 52.2 VM FiO 2 < 50% 24 22.2 43 26.4 VM FiO 2 ≥ 50% or MV 48 44.4 35 21.5 Sputum suction frequency 0 (2.5, 16) 12 (3, 19) 2 94 87.0 151 92.6 ≤2 14 13.0 12 7.4 HFCWO use HFCWO days, median (IQR) 7 (6, 11) 8 (6, 10) 0.427 HFCWO frequency, n (%) 0.576 Once daily 23 21.3 29 17.8 Twice daily 85 78.7 134 82.2 * Fisher exact test and independent t test were used to calculate continuous variables and category variables, respectively. BMI, body mass index; COPD, chronic obstructive pulmonary disease; CKD, chronic kidney disease; CVA, cerebrovascular accident; DM, diabetes mellitus; HFCWO, high frequency chest wall oscillation; ICU, intensive care unit; IPPB, Intermittent positive pressure breathing; MV, mechanical ventilation; NIV, non-invasive ventilation; SARI, severe acute respiratory infection; VM, Venturi Mask. The clinical outcomes of the enrolled patients are listed in Table 2 . Compared to using HFCWO alone, patients using both IPPB and HFCWO had shorter hospital stays (median hospital days: 21 vs. 27 days, P = 0.002), less frequent hospital stays of more than 23 days (41.1% vs. 61.1%, P = 0.002), and experienced a greater decline in sputum suction frequency (62.58% vs. 30.56%, P < 0.001). However, after excluding hospital days before the use of HFCWO, there was no statistical difference in hospital days between the two groups. There was also no statistical difference between the two groups in terms of oxygen demand post-HFCWO, tapering off oxygen post-HFCWO, respiratory failure, ICU admission, and hospital death. Table 2 Clinical outcomes for enrolled patients who received HFCWO treatment No IPPB use (N = 108) IPPB use (N = 163) N (IQR or %) N (IQR or %) P-value * Total hospital days, median (IQR) 27 30 21 16 0.002 Total hospital days > 23 days 66 61.1 67 41.1 0.002 Post HFCWO hospital days 15 (9, 24.5) 13 (9, 21) 0.285 Post HFCWO hospital stay > 15 days 50 46.3 61 37.4 0.184 Decrease sputum suction frequency 33 30.6 102 62.6 < 0.001 Post HFCWO oxygen use 0.538 Room air or nasal cannula 77 71.3 121 74.2 VM FiO2 < 50% 13 12.0 13 8.0 VM FiO2≥50% or MV 18 16.7 29 17.8 Taper off oxygen post HFCWO 48 44.4 77 47.2 0.743 SARI CXR score decline 46 44.2 58 36.0 0.227 Respiratory failure 5 4.6 14 8.6 0.314 IMV 2 1.9 8 4.9 0.324 NIV 3 2.8 9 5.5 0.373 ICU admission 6 5.6 11 6.8 0.888 Hospital death 13 12.0 29 17.8 0.267 * Fisher exact test and Mann-Whiteny U test were used to calculate category variables and continuous variables, respectively. HFCWO, high frequency chest wall oscillation; ICU, intensive care unit; IMV, invasive mechanical ventilation; IPPB, Intermittent positive pressure breathing; IQR, interquartile range; MV, mechanical ventilation; NIV, non-invasive ventilation; SARI, severe acute respiratory infection; VM, Venturi Mask. In univariable logistic regression analysis, patients using both IPPB and HFCWO had a lower risk of total hospital days > 23 days and oxygen need post-HFCWO, and had higher odds of decreasing sputum suction frequency. After multivariate analysis are listed in Table 3 ., which adjusting for confounders, patients using both IPPB and HFCWO were associated with a lower risk of total hospital days > 23 days (OR: 0.49, 95% CI: 0.28–0.83, P = 0.008), oxygen need post-HFCWO (OR: 0.55, 95% CI: 0.33–0.91, P = 0.021), and had a higher likelihood of decreased sputum suction frequency (OR: 2.91, 95% CI: 1.46–5.78, P = 0.002). Using both IPPB and HFCWO was not associated with a decline in SARI CXR scores, lower post-HFCWO hospital days, a decreased risk of respiratory failure, ICU admission, and hospital death. Table 3 The univariate and multivariate logistic regression analysis of odds ratio of clinical outcomes for enrolled patients who received HFCWO treatment with or without IPPB use Univariate Multivariate * Clinical outcomes OR 95% CI p OR 95% CI p Total hospital stay > 23 days 0.44 (0.27, 0.73) 0.001 0.49 (0.28, 0.83) 0.008 Post HFCWO hospital stay > 15 days 0.69 (0.42, 1.14) 0.147 1.00 (0.56, 1.78) 0.992 Decrease sputum suction frequency 3.80 (2.26, 6.38) < 0.001 2.91 (1.46, 5.78) 0.002 Oxygen need post HFCWO 0.53 (0.32, 0.87) 0.013 0.55 (0.33, 0.91) 0.021 SARI CXR score decline 0.71 (0.43, 1.17) 0.182 0.72 (0.41, 1.25) 0.237 Respiratory failure 1.94 (0.68, 5.54) 0.218 1.76 (0.58, 5.33) 0.318 Post HFCWO with IMV 2.74 (0.57,13.13) 0.209 2.74 (0.57,13.13) 0.209 Post HFCWO with NIV 2.05 (0.54, 7.73) 0.292 1.57 (0.38, 6.57) 0.534 ICU admission 1.23 (0.44, 3.43) 0.692 1.64 (0.56, 4.77) 0.363 Hospital death 1.58 (0.78, 3.20) 0.203 2.04 (0.96, 4.32) 0.064 * Multivariate model adjusted the covariates including the group of IPPB use and other covariates selected in the univariate model with p-values less than 0.1. The covariates included age, sex, BMI level, active smoking, COPD, bronchiectasis, pulmonary fibrosis, CVA, heart failure, CKD, type of oxygen demand, sputum suction frequency, baseline SARI score, HFCWO days and frequency of HFCWO. Additionally, using HFCWO twice daily did not improve hospital days, sputum suction frequency, oxygen demand, respiratory failure, ICU admission, and hospital death, compared to using HFCWO once daily (data not shown). Discussion After analyzing a retrospective cohort of 271 pneumonia patients who received HFCWO in our hospital, we found that the combination of IPPB and HFCWO shortened total hospital stays, decreased the frequency of sputum suction, and reduced oxygen support levels more effectively than using HFCWO alone. However, adding IPPB to HFCWO did not further decrease hospital stay post-HFCWO use, nor did it reduce the risk of respiratory failure, ICU admissions, or hospital mortality. Our results showed that the combination of IPPB and HFCWO may offer clinical benefits in facilitating sputum clearance and tapering oxygen support. However, this combination did not reduce the hospital stay, risk of respiratory failure, or hospital mortality. In our study, we found that adding IPPB to HFCWO can facilitate sputum clearance and improve oxygenation in pneumonia patients. Pneumonia induces an inflammatory process in the respiratory system, increasing pulmonary vasodilatation and airway blocking with secretions, leading to ventilation-perfusion mismatch and hypoxemia. (18) IPPB can delivers airflow into the lungs by creating a positive pressure gradient, preventing and treating pulmonary atelectasis, aiding sputum mobilization, and improving lung compliance. (19) On the other hand, HFCWO moves mucus from the peripheral lung to the central airway by producing high-frequency oscillations. (6) There may be a synergistic effect between IPPB and HFCWO for lung expansion and secretion clearance, further improving oxygenation and decreasing the need for sputum suction in pneumonia patients. We found that adding IPPB to HFCWO did not further shorten hospital stays, nor did it lower the risk of respiratory failure, ICU admission, or mortality. To the best of our knowledge, there is no published research focusing on the combination of IPPB and HFCWO for pneumonia patients. In a previous randomized controlled trial with a small cohort conducted by Chen et al., IPPB might improve the weaning rate and reduce ventilator days for patients with prolonged mechanical ventilation. (20) A previous meta-analysis that included 13 studies assessed the effect of HFCWO on AECOPD patients and found that HFCWO may have the advantage of decreasing the length of hospital stays for AECOPD patients. (13) Although our study did not find a significant impact on hospital stay, respiratory failure, or mortality for the combination of the two devices, the results might differ for different populations with pneumonia, such as those with neuromuscular disorders, cystic fibrosis, and bronchiectasis, where airway clearance is more critical. Our study found that the combination of IPPB and HFCWO provided clinical benefits for pneumonia patients. However, IPPB also has some limitations and potential risks. The most well-recognized injuries include an increased risk of pneumothorax, pneumomediastinum, and subcutaneous emphysema. (21, 22) Another issue is patient tolerance to the device, as the increase in airway pressure may cause discomfort, leading to difficulty in cooperating with IPPB. Common interface-related side effects include discomfort, erythema, pressure ulcers, and skin rash. (19) Given these issues, it is crucial to closely monitor the patient's condition during IPPB intervention. IPPB should be used with caution in the presence of structure lung disease, and patients at risk of pneumothorax, had unstable rib fractures, and facial trauma and deformities. (22, 23) Clinical healthcare providers should carefully assess the benefits and risks of using IPPB for these patients. This study had some limitations. First, the patients were retrospectively enrolled at a single medical center in Southern Taiwan, with a small sample size, and information bias cannot be excluded. Therefore, the results should be generalized with caution. Second, the decision to use IPPB was based on clinical assessment. The characteristics between patients with or without IPPB were different, so confounding by indication cannot be completely excluded. However, we included covariates related to patient demographics and pneumonia severity in the multivariable analysis, which likely adjusted for many confounders. Conclusion The combination of IPPB and HFCWO demonstrated clinical benefits by decreasing the frequency of sputum suction and reducing oxygen support levels in pneumonia patients more effectively than HFCWO alone. However, it did not further decrease hospital stay post-HFCWO use, reduce the risk of respiratory failure, ICU admissions, or hospital mortality. Despite these limitations, the combined use of IPPB and HFCWO may enhance sputum clearance and oxygen support management in pneumonia treatment. Further large-scale prospective cohort studies are necessary to confirm the efficacy of this combined management approach. Abbreviations ACT, airway clearance techniques HFCWO, high-frequency chest wall oscillation IPPB, intermittent positive pressure breathing CPT, chest physiotherapy CF, cystic fibrosis NMD, neuromuscular disease COPD, chronic obstructive pulmonary disease BAL, bronchoscopic alveolar lavage BMI, body mass index CXR, chest X-ray NIV, non-invasive ventilation IMV, invasive mechanical ventilation SARI, severe acute respiratory infection IICP, increase intracranial pressure IPAP, inspiratory positive airway pressure EPAP, expiratory positive airway pressure IQR, interquartile range ORs, odds ratios (ORs) CIs, confidence intervals Declarations Ethics approval and consent to participate This study was approved by the local ethics committee before commencement (The Institutional Review Board of National Cheng Kung University Hospital, IRB number: A-ER-112-261. Informed consent was waived by the Institutional Review Board of National Cheng Kung University Hospital because of the use of de-identified information. We confirmed that all the study protocols involving human data were in accordance with the relevant institutional, national, and international regulations and guidelines and the Declaration of Helsinki. Consent for publication Not applicable. Availability of data and materials All data are available from the corresponding author upon reasonable request. Conflict of interest statement All authors declare no conflict of interest. Funding This study was funded by grants from the National Cheng Kung University Hospital (NCKUH-11206001 A-ER-112-261) and the National Science and Technology Council (NSCT-110-2314-B-006 -098 -MY3). Author contributions CWK, HLL and TWC designed the study. TWC and YCK searched the literature. TWC and YCK collected the data. SHL performed the statistical analysis. TWC, YCK and CWK wrote the manuscript. 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International Consensus Conferences in Intensive Care Medicine: noninvasive positive pressure ventilation in acute Respiratory failure. Am J Respir Crit Care Med. 2001;163(1):283-91. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Published Journal Publication published 03 May, 2025 Read the published version in BMC Pulmonary Medicine → Version 1 posted Editorial decision: Revision requested 31 Jul, 2024 Editor assigned by journal 31 Jul, 2024 Submission checks completed at journal 31 Jul, 2024 First submitted to journal 12 Jul, 2024 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-4730848","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":334416141,"identity":"128d56a0-42a2-4251-a41e-96aaba445000","order_by":0,"name":"Ta-Wei Chao","email":"","orcid":"","institution":"National Cheng Kung University Hospital","correspondingAuthor":false,"prefix":"","firstName":"Ta-Wei","middleName":"","lastName":"Chao","suffix":""},{"id":334416142,"identity":"ec479fc0-627a-4c85-bbc9-9be02c0c1fce","order_by":1,"name":"Ya-Chen Kao","email":"","orcid":"","institution":"National Cheng Kung University Hospital, National Cheng Kung University","correspondingAuthor":false,"prefix":"","firstName":"Ya-Chen","middleName":"","lastName":"Kao","suffix":""},{"id":334416143,"identity":"4d64d210-afa3-45c1-8610-cfb36ff3ec6d","order_by":2,"name":"Hui-Ling Liu","email":"","orcid":"","institution":"National Cheng Kung University Hospital","correspondingAuthor":false,"prefix":"","firstName":"Hui-Ling","middleName":"","lastName":"Liu","suffix":""},{"id":334416144,"identity":"86ee3c01-6184-4193-9a1c-b25f5d233630","order_by":3,"name":"Sheng-Hsiang Lin","email":"","orcid":"","institution":"National Cheng Kung University","correspondingAuthor":false,"prefix":"","firstName":"Sheng-Hsiang","middleName":"","lastName":"Lin","suffix":""},{"id":334416145,"identity":"2bd8cd19-de68-43d0-ab89-bd11b39046c3","order_by":4,"name":"Chin-Wei Kuo","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAvElEQVRIiWNgGAWjYBACCQke9s8//9kAmYyNB4jVwsbMwJYG0tJAkpbDYA5xWiRn9x57XMBz3m5t+2GgLTU20QS1SMucSzeeIXE7eduZRKCWY2m5DYS0yEnkGEjwGNxONjsA1MLYcJhYLQnnks3OPyRSi7REjpk0z4EDdmY3iLVFcs4ZY8OZDckJZjeAtiQQ4xeJ2z2GDz422NmbnU9/+OBDjQ1hLTCQCFaZQKxyELAnRfEoGAWjYBSMMAAAL+dFvzWyS+gAAAAASUVORK5CYII=","orcid":"","institution":"National Cheng Kung University Hospital, National Cheng Kung University","correspondingAuthor":true,"prefix":"","firstName":"Chin-Wei","middleName":"","lastName":"Kuo","suffix":""}],"badges":[],"createdAt":"2024-07-12 14:08:55","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4730848/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4730848/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1186/s12890-025-03685-y","type":"published","date":"2025-05-03T15:57:34+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":64005411,"identity":"983aa84e-b18c-4862-a51a-bec40fe77d1e","added_by":"auto","created_at":"2024-09-04 21:37:44","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":169901,"visible":true,"origin":"","legend":"\u003cp\u003eThe chest X-ray findings in the Severe Acute Respiratory Infection (SARI) CXR severity scoring system.\u003c/p\u003e","description":"","filename":"OnlineFigure1IPPB.png","url":"https://assets-eu.researchsquare.com/files/rs-4730848/v1/ca2cf94d1251028cdeb972f6.png"},{"id":64005412,"identity":"af117ab1-51ae-44c2-bec1-467097c98f7c","added_by":"auto","created_at":"2024-09-04 21:37:44","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":18674,"visible":true,"origin":"","legend":"\u003cp\u003eThe algorithm for patient enrollment in this study.\u003c/p\u003e","description":"","filename":"OnlineFigure2IPPB.png","url":"https://assets-eu.researchsquare.com/files/rs-4730848/v1/6467cddfd128ab09f9907663.png"},{"id":81987916,"identity":"434831c5-8293-4e54-bad5-f465562b4321","added_by":"auto","created_at":"2025-05-05 16:06:54","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1276017,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4730848/v1/7bbe903f-d722-4845-81cc-e537fb069a38.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Investigating the Effectiveness of Combining High-Frequency Chest Wall Oscillation with Intermittent Positive Pressure Breathing in Pneumonia Patients: A Retrospective Cohort Study Running head: Effectiveness of Combination of HFCWO and IPPB in Pneumonia","fulltext":[{"header":"Introduction","content":"\u003cp\u003ePneumonia is a prevalent disease influenced by geography, season, and population characteristics. The estimated worldwide incidence of community-acquired pneumonia varies between 1.5 to 14 cases per 1000 person-years (1). Despite the development of numerous preventive and therapeutic management strategies, pneumonia remains a significant public health concern and a leading cause of mortality and morbidity worldwide (2, 3). For adult pneumonia, the mortality rate remains high, reaching up to 23% for patients admitted to the intensive care unit (1). The expenditures averaged of community-acquired pneumonia related hospitalization is 33,380 USD and the long-term phase averaged 83,463 USD (4). Even though antibiotics are the primary treatment for pneumonia, the high incidence and mortality rates, along with the increasing medical costs, continue to pose a significant burden on patients. On the other hands, supportive therapies, such as oxygen therapy and chest physiotherapy (CPT), have been proven effective and widely used (5).\u003c/p\u003e \u003cp\u003eAirway clearance techniques (ACT) are among the most important components of CPT. They refer to a variety of different strategies used to eliminate excess secretions, reduce airway obstruction, ameliorate pulmonary atelectasis, and prevent respiratory tract infections that can lead to respiratory failure when an endotracheal tube is intubated (6). In recent years, there has been a focus on implementing ACTs for specific populations, including individuals with conditions such as bronchiectasis, cystic fibrosis (CF), and neuromuscular disease (NMD). In these groups, abnormal respiratory tract structures, changes in mucus characteristics, and muscle weakness contribute to impaired cough function, leading to the inability to effectively clear mucus (7). High-frequency chest wall oscillation (HFCWO) is a widely used strategy for secretion clearance. It involves the use of an inflatable vest connected to tubes connected to a compressor that can generate rapid inflation and deflation of the vest, producing oscillations that move mucus from the chest wall to the lungs (6, 8). HFCWO creates oscillations with a frequency of 5\u0026ndash;25 Hz and pulse pressure settings ranging from 1\u0026ndash;5 cmH2O, which are transmitted through the chest wall to the entire bronchial tree. Several studies have mentioned that HFCWO therapy is as effective as or superior to other ACTs in acute exacerbation patients with CF (9\u0026ndash;12). The potential benefits of HFCWO therapy have also been reported in systematic reviews or clinical trials for chronic obstructive pulmonary disease (COPD), bronchiectasis, and neuromuscular disease (13\u0026ndash;15). Although CPT is not traditionally recommended for the treatment of uncomplicated pneumonia, (16) new clinical evidence suggested that combining HFCWO with other treatments may offer additional benefits. For instance, Shi et al. demonstrated that HFCWO, when combined with bronchoscopic alveolar lavage (BAL), can reduce the mean duration of ICU stays and the use of mechanical ventilation in pneumonia patients, compared to BAL alone (5).\u003c/p\u003e \u003cp\u003eIntermittent positive pressure breathing (IPPB) provides lung expansion through short-term, intermittent mechanical ventilation, and it can also deliver aerosol medication or assist in ventilation. IPPB includes pressure and time-limited ventilation, as well as pressure, time, and flow-cycled ventilation, which can be administered to both patients with artificial airways and those who are not intubated (16). Combining IPPB and HFCWO can simultaneously enhance patient lung ventilation and mucus clearance, achieving an additive effect. However, the clinical effectiveness of combining HFCWO with IPPB in adult pneumonia patients remains unclear.\u003c/p\u003e \u003cp\u003eTo investigate the clinical effectiveness of combination of IPPB and HFCWO for pneumonia treatment, we hypothesized that patients who receive the combination of IPPB and HFCWO treatment would demonstrate superior clinical outcomes compared to those who receive either one of these treatments individually or receive no additional treatment. To prove the hypothesis, we conducted a retrospective cohort study utilizing a pneumonia cohort at a college hospital in southern Taiwan to investigate the treatment effectiveness of the combined use of IPPB and HFCWO for patients with pneumonia.\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003ePatient Enrollment and Study Design\u003c/h2\u003e \u003cp\u003eThis study was conducted at National Cheng Kung University Hospital (NCKUH), a college hospital serving a population of 1.86\u0026nbsp;million inhabitants in Tainan City, Taiwan, as of 2022. The Institutional Review Board of NCKUH approved this study before its commencement (Approval Number: A-ER-112-261). Informed consent was waived due to the retrospective study design. Patients aged\u0026thinsp;\u0026ge;\u0026thinsp;18 years old, admitted to NCKUH for pneumonia between January 1, 2020, and December 31, 2022, and receiving HFCWO therapy were enrolled. Patients were excluded if they were 1) received HFCWO for less than 5 days, 2) received HFCWO in the ICU, 3) long-term mechanical ventilation dependence. For patients who received multiple HFCWO therapy sessions during their hospitalization, only the first HFCWO therapy session was included into the analysis. To prevent repeated measurements, we only analyzed the first admission for patients with multiple admissions for pneumonia during the study period.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003eData Collection, and the definition of variables and outcomes\u003c/h2\u003e \u003cp\u003ePatient information, including age, sex, body mass index (BMI), smoking status, comorbidities, oxygen usage, frequency of sputum suction, frequency and duration of HFCWO, the use of IPPB, chest X-ray (CXR) results, hospitalization duration, mechanical ventilation usage, admission to the ICU, and hospital mortality, was extracted from electronic medical records in the NCKUH database. Patients received non-invasive ventilation (NIV), invasive mechanical ventilation (IMV) or dead of pneumonia were defined as respiratory failure. The frequency of sputum suction indicates the average number of suction times during the 3 days before and after the completion of HFCWO therapy. Additionally, oxygen usage refers to the highest-intensity oxygen delivery device used during the 3 days before and after the completion of HFCWO therapy. The definition of post-HFCWO use hospital days is the interval between the last day of HFCWO use and the discharge day.\u003c/p\u003e \u003cp\u003ePneumonia severity was assessed using the Severe Acute Respiratory Infection (SARI) CXR severity scoring system, a validated five-point CXR scoring tool that demonstrates good agreement among clinicians with varying levels of experience. (17) In brief, the SARI scoring system categorizes patients into five levels based on CXR findings. Patients with normal findings, patchy atelectasis and/or hyperinflation and/or bronchial wall thickening, focal consolidation, multifocal consolidation, and diffuse alveolar changes are classified as scores 1 to 5, respectively. (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e) In this study, the SARI score was initially calculated by an internal medicine doctor and subsequently verified by a pulmonologist.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003eThe indication and setting of HFCWO and IPPB\u003c/h2\u003e \u003cp\u003eThe indications for High-Frequency Chest Wall Oscillation (HFCWO) in pneumonia patients at NCKUH include poor airway clearance function, acute phase of COPD, CF, and bronchiectasis induced high sputum volume, and pulmonary atelectasis. Contraindications for HFCWO include unstable hemodynamic, massive hemoptysis, increase intracranial pressure (IICP), rib fracture, chest wall injury, and recent chest surgery. IPPB is routinely added for patients receiving HFCWO, except for those at risk of pneumothorax (e.g., large bullae, history of pneumothorax, or recent chest surgery or biopsy), unable to cooperate with IPPB, IICP, or with facial trauma or deformity. All applications of HFCWO and IPPB at NCKUH require approval from a pulmonologist and respiratory therapist following a comprehensive patient evaluation.\u003c/p\u003e \u003cp\u003eThe medical device for HFCWO is COMFORTCOUGH\u0026reg; II (Seoil Pacific Corp., South Korea). We configure the HFCWO device to \"percussor\" mode, setting the amplitude and frequency of percussion pressure based on patient comfort and clinical effectiveness. The amplitude of pressure was adjusted from 40 to 60 cmH\u003csub\u003e2\u003c/sub\u003eO and the frequency from 400 to 600 Hz, once or twice daily dependent on the availability of devices and respiratory therapists. The IPPB device used is FlexoTM Bi-Level, set to \"S/T\" mode. The settings for inspiratory positive airway pressure (IPAP) and expiratory positive airway pressure (EPAP) are 8\u0026ndash;15 cmH\u003csub\u003e2\u003c/sub\u003eO and 6\u0026ndash;8 cmH\u003csub\u003e2\u003c/sub\u003eO, respectively. These settings aim to achieve a lung volume expansion targeted at 1.5 times the predicted tidal volume, which is calculated based on the predicted body weight (8\u0026ndash;10 ml/kg of predicted body weight). The respiratory rate was set at 10\u0026ndash;12 breaths per minute, with the inspiratory time set at approximately 33% of the single breathing cycle. Each setting was adjusted based on clinical effectiveness and patient comfort.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003eStatistical Analysis\u003c/h2\u003e \u003cp\u003eThe collected data were presented as numbers (percentages), means (standard deviations), or medians (interquartile range [IQR]) depending on the nature of the data. Independent t-tests and Mann-Whitney U tests were utilized to analyze continuous variables with or without a normal distribution, respectively. Fisher\u0026rsquo;s exact test was employed to analyze categorical variables. Univariable and multivariable logistic regression analyses were conducted to investigate the effectiveness of IPPB and HFCWO. Multivariate model adjusted the covariates including the group of IPPB use and other covariates selected in the univariate model with p-values less than 0.1. Associations were established using odds ratios (ORs) and 95% confidence intervals (CIs). All P-values were calculated as two-sided, and a P\u0026thinsp;\u0026lt;\u0026thinsp;0.05 was considered statistically significant. All statistical analyses were carried out using SAS software (version 9.4; SAS Institute, Cary, NC, USA).\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003eBetween January 1, 2020, and December 31, 2022, a total of 863 patients at NCKUH received HFCWO for pneumonia. After excluding patients with repeated admissions for pneumonia (n\u0026thinsp;=\u0026thinsp;186), those treated in the ICU (n\u0026thinsp;=\u0026thinsp;208), and those who received HFCWO for less than 5 days (n\u0026thinsp;=\u0026thinsp;198), 271 patients were eligible for analysis \u003cb\u003e(\u003c/b\u003eFig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e\u003cb\u003e)\u003c/b\u003e. Among these patients, 163 received a combination of IPPB and HFCWO for pneumonia, while 108 received HFCWO alone \u003cb\u003e(\u003c/b\u003eTable\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e\u003cb\u003e)\u003c/b\u003e. Compared to patients who received HFCWO alone, those who received both IPPB and HFCWO were older, need lower oxygen support level and required more frequent sputum suctioning. There was no difference between the two groups in sex, BMI, smoking status, comorbidities, baseline SARI CXR scores, the number of HFCWO days, or the frequency of HFCWO use.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eBasic demographic information and clinical outcomes of enrolled patients who received HFCWO treatment\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"9\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003eNo IPPB use (N\u0026thinsp;=\u0026thinsp;108)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003eIPPB use (N\u0026thinsp;=\u0026thinsp;163)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eN or median\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e(%) or IQR\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eN or median\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e(%) or IQR\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eP-value\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eBasic information\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge, median (IQR)(year)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e78.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e(70, 85.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e83\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e(74, 89)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.008\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMale, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e78\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e72.22\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e116\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e71.17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.959\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBMI level, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.290\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUnderweight\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e27.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e47\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e28.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNormal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e63\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e58.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e103\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e63.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOverweight\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e13.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e8.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eActive smoking, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e14.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e9.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.291\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eComorbidities, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCOPD\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e17.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e27\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e16.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.956\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBronchiectasis\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e10.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e6.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.431\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePulmonary fibrosis\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e3.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.483\u003csup\u003e\u0026dagger;\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCVA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e27.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e43\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e26.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.909\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHeart failure\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e17.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e39.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e23.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.274\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCKD\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e27.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e49\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e30.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.788\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eBaseline clinical severity\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOxygen demand, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRoom air or N/C\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e36\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e33.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e85\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e52.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVM FiO\u003csub\u003e2\u003c/sub\u003e\u0026thinsp;\u0026lt;\u0026thinsp;50%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e22.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e43\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e26.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVM FiO\u003csub\u003e2\u003c/sub\u003e\u0026thinsp;\u0026ge;\u0026thinsp;50% or MV\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e48\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e44.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e35\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e21.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSputum suction frequency\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e(2.5, 16)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e(3, 19)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBaseline SARI CXR score\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.186\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026gt;2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e94\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e87.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e151\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e92.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026le;2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e13.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e7.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eHFCWO use\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHFCWO days, median (IQR)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e(6, 11)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e(6, 10)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.427\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHFCWO frequency, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.576\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOnce daily\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e23\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e21.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e29\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e17.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTwice daily\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e85\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e78.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e134\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e82.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"9\"\u003e\u003csup\u003e*\u003c/sup\u003eFisher exact test and independent t test were used to calculate continuous variables and category variables, respectively.\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"9\"\u003eBMI, body mass index; COPD, chronic obstructive pulmonary disease; CKD, chronic kidney disease; CVA, cerebrovascular accident; DM, diabetes mellitus; HFCWO, high frequency chest wall oscillation; ICU, intensive care unit; IPPB, Intermittent positive pressure breathing; MV, mechanical ventilation; NIV, non-invasive ventilation; SARI, severe acute respiratory infection; VM, Venturi Mask.\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eThe clinical outcomes of the enrolled patients are listed in Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e. Compared to using HFCWO alone, patients using both IPPB and HFCWO had shorter hospital stays (median hospital days: 21 vs. 27 days, P\u0026thinsp;=\u0026thinsp;0.002), less frequent hospital stays of more than 23 days (41.1% vs. 61.1%, P\u0026thinsp;=\u0026thinsp;0.002), and experienced a greater decline in sputum suction frequency (62.58% vs. 30.56%, P\u0026thinsp;\u0026lt;\u0026thinsp;0.001). However, after excluding hospital days before the use of HFCWO, there was no statistical difference in hospital days between the two groups. There was also no statistical difference between the two groups in terms of oxygen demand post-HFCWO, tapering off oxygen post-HFCWO, respiratory failure, ICU admission, and hospital death.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eClinical outcomes for enrolled patients who received HFCWO treatment\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"9\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003eNo IPPB use (N\u0026thinsp;=\u0026thinsp;108)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003eIPPB use (N\u0026thinsp;=\u0026thinsp;163)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eN\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e(IQR or %)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eN\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e(IQR or %)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eP-value\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTotal hospital days, median (IQR)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e27\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.002\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTotal hospital days\u0026thinsp;\u0026gt;\u0026thinsp;23 days\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e66\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e61.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e67\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e41.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.002\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePost HFCWO hospital days\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e(9, 24.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e(9, 21)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.285\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePost HFCWO hospital stay\u0026thinsp;\u0026gt;\u0026thinsp;15 days\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e46.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e61\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e37.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.184\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDecrease sputum suction frequency\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e33\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e30.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e102\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e62.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePost HFCWO oxygen use\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.538\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRoom air or nasal cannula\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e77\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e71.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e121\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e74.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVM FiO2\u0026thinsp;\u0026lt;\u0026thinsp;50%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e12.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e8.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVM FiO2\u0026ge;50% or MV\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e16.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e29\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e17.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTaper off oxygen post HFCWO\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e48\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e44.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e77\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e47.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.743\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSARI CXR score decline\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e46\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e44.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e58\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e36.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.227\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRespiratory failure\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e8.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.314\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIMV\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e4.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.324\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNIV\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e5.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.373\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eICU admission\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e6.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.888\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHospital death\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e12.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e29\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e17.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.267\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"9\"\u003e\u003csup\u003e*\u003c/sup\u003eFisher exact test and Mann-Whiteny U test were used to calculate category variables and continuous variables, respectively.\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"9\"\u003eHFCWO, high frequency chest wall oscillation; ICU, intensive care unit; IMV, invasive mechanical ventilation; IPPB, Intermittent positive pressure breathing; IQR, interquartile range; MV, mechanical ventilation; NIV, non-invasive ventilation; SARI, severe acute respiratory infection; VM, Venturi Mask.\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eIn univariable logistic regression analysis, patients using both IPPB and HFCWO had a lower risk of total hospital days\u0026thinsp;\u0026gt;\u0026thinsp;23 days and oxygen need post-HFCWO, and had higher odds of decreasing sputum suction frequency. After multivariate analysis are listed in Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e., which adjusting for confounders, patients using both IPPB and HFCWO were associated with a lower risk of total hospital days\u0026thinsp;\u0026gt;\u0026thinsp;23 days (OR: 0.49, 95% CI: 0.28\u0026ndash;0.83, P\u0026thinsp;=\u0026thinsp;0.008), oxygen need post-HFCWO (OR: 0.55, 95% CI: 0.33\u0026ndash;0.91, P\u0026thinsp;=\u0026thinsp;0.021), and had a higher likelihood of decreased sputum suction frequency (OR: 2.91, 95% CI: 1.46\u0026ndash;5.78, P\u0026thinsp;=\u0026thinsp;0.002). Using both IPPB and HFCWO was not associated with a decline in SARI CXR scores, lower post-HFCWO hospital days, a decreased risk of respiratory failure, ICU admission, and hospital death.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eThe univariate and multivariate logistic regression analysis of odds ratio of clinical outcomes for enrolled patients who received HFCWO treatment with or without IPPB use\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"9\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c5\" namest=\"c3\"\u003e \u003cp\u003eUnivariate\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c9\" namest=\"c7\"\u003e \u003cp\u003eMultivariate\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eClinical outcomes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eOR\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e95% CI\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003ep\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eOR\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e95% CI\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003ep\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTotal hospital stay\u0026thinsp;\u0026gt;\u0026thinsp;23 days\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.44\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e(0.27, 0.73)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.49\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e(0.28, 0.83)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.008\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePost HFCWO hospital stay\u0026thinsp;\u0026gt;\u0026thinsp;15 days\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.69\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e(0.42, 1.14)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.147\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e1.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e(0.56, 1.78)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.992\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDecrease sputum suction frequency\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3.80\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e(2.26, 6.38)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e2.91\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e(1.46, 5.78)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.002\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOxygen need post HFCWO\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.53\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e(0.32, 0.87)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.013\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.55\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e(0.33, 0.91)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.021\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSARI CXR score decline\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.71\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e(0.43, 1.17)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.182\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.72\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e(0.41, 1.25)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.237\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRespiratory failure\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.94\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e(0.68, 5.54)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.218\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e1.76\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e(0.58, 5.33)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.318\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePost HFCWO with IMV\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2.74\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e(0.57,13.13)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.209\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e2.74\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e(0.57,13.13)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.209\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePost HFCWO with NIV\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2.05\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e(0.54, 7.73)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.292\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e1.57\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e(0.38, 6.57)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.534\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eICU admission\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.23\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e(0.44, 3.43)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.692\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e1.64\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e(0.56, 4.77)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.363\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHospital death\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.58\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e(0.78, 3.20)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.203\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e2.04\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e(0.96, 4.32)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.064\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"9\" nameend=\"c9\" namest=\"c1\"\u003e \u003cp\u003e\u003csup\u003e*\u003c/sup\u003eMultivariate model adjusted the covariates including the group of IPPB use and other covariates selected in the univariate model with p-values less than 0.1. The covariates included age, sex, BMI level, active smoking, COPD, bronchiectasis, pulmonary fibrosis, CVA, heart failure, CKD, type of oxygen demand, sputum suction frequency, baseline SARI score, HFCWO days and frequency of HFCWO.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eAdditionally, using HFCWO twice daily did not improve hospital days, sputum suction frequency, oxygen demand, respiratory failure, ICU admission, and hospital death, compared to using HFCWO once daily (data not shown).\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eAfter analyzing a retrospective cohort of 271 pneumonia patients who received HFCWO in our hospital, we found that the combination of IPPB and HFCWO shortened total hospital stays, decreased the frequency of sputum suction, and reduced oxygen support levels more effectively than using HFCWO alone. However, adding IPPB to HFCWO did not further decrease hospital stay post-HFCWO use, nor did it reduce the risk of respiratory failure, ICU admissions, or hospital mortality. Our results showed that the combination of IPPB and HFCWO may offer clinical benefits in facilitating sputum clearance and tapering oxygen support. However, this combination did not reduce the hospital stay, risk of respiratory failure, or hospital mortality.\u003c/p\u003e \u003cp\u003eIn our study, we found that adding IPPB to HFCWO can facilitate sputum clearance and improve oxygenation in pneumonia patients. Pneumonia induces an inflammatory process in the respiratory system, increasing pulmonary vasodilatation and airway blocking with secretions, leading to ventilation-perfusion mismatch and hypoxemia. (18) IPPB can delivers airflow into the lungs by creating a positive pressure gradient, preventing and treating pulmonary atelectasis, aiding sputum mobilization, and improving lung compliance. (19) On the other hand, HFCWO moves mucus from the peripheral lung to the central airway by producing high-frequency oscillations. (6) There may be a synergistic effect between IPPB and HFCWO for lung expansion and secretion clearance, further improving oxygenation and decreasing the need for sputum suction in pneumonia patients.\u003c/p\u003e \u003cp\u003eWe found that adding IPPB to HFCWO did not further shorten hospital stays, nor did it lower the risk of respiratory failure, ICU admission, or mortality. To the best of our knowledge, there is no published research focusing on the combination of IPPB and HFCWO for pneumonia patients. In a previous randomized controlled trial with a small cohort conducted by Chen et al., IPPB might improve the weaning rate and reduce ventilator days for patients with prolonged mechanical ventilation. (20) A previous meta-analysis that included 13 studies assessed the effect of HFCWO on AECOPD patients and found that HFCWO may have the advantage of decreasing the length of hospital stays for AECOPD patients. (13) Although our study did not find a significant impact on hospital stay, respiratory failure, or mortality for the combination of the two devices, the results might differ for different populations with pneumonia, such as those with neuromuscular disorders, cystic fibrosis, and bronchiectasis, where airway clearance is more critical.\u003c/p\u003e \u003cp\u003eOur study found that the combination of IPPB and HFCWO provided clinical benefits for pneumonia patients. However, IPPB also has some limitations and potential risks. The most well-recognized injuries include an increased risk of pneumothorax, pneumomediastinum, and subcutaneous emphysema. (21, 22) Another issue is patient tolerance to the device, as the increase in airway pressure may cause discomfort, leading to difficulty in cooperating with IPPB. Common interface-related side effects include discomfort, erythema, pressure ulcers, and skin rash. (19) Given these issues, it is crucial to closely monitor the patient's condition during IPPB intervention. IPPB should be used with caution in the presence of structure lung disease, and patients at risk of pneumothorax, had unstable rib fractures, and facial trauma and deformities. (22, 23) Clinical healthcare providers should carefully assess the benefits and risks of using IPPB for these patients.\u003c/p\u003e \u003cp\u003eThis study had some limitations. First, the patients were retrospectively enrolled at a single medical center in Southern Taiwan, with a small sample size, and information bias cannot be excluded. Therefore, the results should be generalized with caution. Second, the decision to use IPPB was based on clinical assessment. The characteristics between patients with or without IPPB were different, so confounding by indication cannot be completely excluded. However, we included covariates related to patient demographics and pneumonia severity in the multivariable analysis, which likely adjusted for many confounders.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThe combination of IPPB and HFCWO demonstrated clinical benefits by decreasing the frequency of sputum suction and reducing oxygen support levels in pneumonia patients more effectively than HFCWO alone. However, it did not further decrease hospital stay post-HFCWO use, reduce the risk of respiratory failure, ICU admissions, or hospital mortality. Despite these limitations, the combined use of IPPB and HFCWO may enhance sputum clearance and oxygen support management in pneumonia treatment. Further large-scale prospective cohort studies are necessary to confirm the efficacy of this combined management approach.\u003c/p\u003e"},{"header":"Abbreviations","content":" \u003cp\u003eACT, airway clearance techniques\u003c/p\u003e \u003cp\u003eHFCWO, high-frequency chest wall oscillation\u003c/p\u003e \u003cp\u003eIPPB, intermittent positive pressure breathing\u003c/p\u003e \u003cp\u003eCPT, chest physiotherapy\u003c/p\u003e \u003cp\u003eCF, cystic fibrosis\u003c/p\u003e \u003cp\u003eNMD, neuromuscular disease\u003c/p\u003e \u003cp\u003eCOPD, chronic obstructive pulmonary disease\u003c/p\u003e \u003cp\u003eBAL, bronchoscopic alveolar lavage\u003c/p\u003e \u003cp\u003eBMI, body mass index\u003c/p\u003e \u003cp\u003eCXR, chest X-ray\u003c/p\u003e \u003cp\u003eNIV, non-invasive ventilation\u003c/p\u003e \u003cp\u003eIMV, invasive mechanical ventilation\u003c/p\u003e \u003cp\u003eSARI, severe acute respiratory infection\u003c/p\u003e \u003cp\u003eIICP, increase intracranial pressure\u003c/p\u003e \u003cp\u003eIPAP, inspiratory positive airway pressure\u003c/p\u003e \u003cp\u003eEPAP, expiratory positive airway pressure\u003c/p\u003e \u003cp\u003eIQR, interquartile range\u003c/p\u003e \u003cp\u003eORs, odds ratios (ORs)\u003c/p\u003e \u003cp\u003eCIs, confidence intervals\u003c/p\u003e \u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was approved by the local ethics committee before commencement (The Institutional Review Board of National Cheng Kung University Hospital, IRB number: A-ER-112-261. Informed consent was waived by the Institutional Review Board of National Cheng Kung University Hospital because of the use of de-identified information. We confirmed that all the study protocols involving human data were in accordance with the relevant institutional, national, and international regulations and guidelines and the Declaration of Helsinki.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll data are available from the corresponding author upon reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConflict of interest statement\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll authors declare no conflict of interest.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was funded by grants from the National Cheng Kung University Hospital (NCKUH-11206001 A-ER-112-261) and the National Science and Technology Council (NSCT-110-2314-B-006 -098 -MY3).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eCWK, HLL and TWC designed the study. TWC and YCK searched the literature. TWC and YCK collected the data. SHL performed the statistical analysis. TWC, YCK and CWK wrote the manuscript. All authors contributed to and approved the final manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgments\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe are greatly thankful to Wan-Ni Chen (MS), statistician from the Biostatistics Consulting Center, Clinical Medicine Research Center of National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, for providing statistical consultation and assistance.\u003c/p\u003e"},{"header":"References","content":"\u003cp\u003eUncategorized References\u003c/p\u003e\n\u003col\u003e\n \u003cli\u003eTsoumani E, Carter JA, Salomonsson S, Stephens JM, Bencina G. Clinical, economic, and humanistic burden of community acquired pneumonia in Europe: a systematic literature review. Expert Rev Vaccines. 2023;22(1):876-84.\u003c/li\u003e\n \u003cli\u003eCilloniz C, Martin-Loeches I, Garcia-Vidal C, San Jose A, Torres A. Microbial Etiology of Pneumonia: Epidemiology, Diagnosis and Resistance Patterns. Int J Mol Sci. 2016;17(12).\u003c/li\u003e\n \u003cli\u003eAverin A, Shaff M, Weycker D, Lonshteyn A, Sato R, Pelton SI. Mortality and readmission in the year following hospitalization for pneumonia among US adults. Respir Med. 2021;185:106476.\u003c/li\u003e\n \u003cli\u003eWeycker D, Moynahan A, Silvia A, Sato R. Attributable Cost of Adult Hospitalized Pneumonia Beyond the Acute Phase. Pharmacoecon Open. 2021;5(2):275-84.\u003c/li\u003e\n \u003cli\u003eChen X, Jiang J, Wang R, Fu H, Lu J, Yang M. Chest physiotherapy for pneumonia in adults. Cochrane Database Syst Rev. 2022;9(9):Cd006338.\u003c/li\u003e\n \u003cli\u003eBelli S, Prince I, Savio G, Paracchini E, Cattaneo D, Bianchi M, et al. Airway Clearance Techniques: The Right Choice for the Right Patient. Front Med (Lausanne). 2021;8:544826.\u003c/li\u003e\n \u003cli\u003eMcCool FD, Rosen MJ. Nonpharmacologic airway clearance therapies: ACCP evidence-based clinical practice guidelines. Chest. 2006;129(1 Suppl):250s-9s.\u003c/li\u003e\n \u003cli\u003eChuang ML, Chou YL, Lee CY, Huang SF. Instantaneous responses to high-frequency chest wall oscillation in patients with acute pneumonic respiratory failure receiving mechanical ventilation: A randomized controlled study. Medicine (Baltimore). 2017;96(9):e5912.\u003c/li\u003e\n \u003cli\u003eVarekojis SM, Douce FH, Flucke RL, Filbrun DA, Tice JS, McCoy KS, Castile RG. A comparison of the therapeutic effectiveness of and preference for postural drainage and percussion, intrapulmonary percussive ventilation, and high-frequency chest wall compression in hospitalized cystic fibrosis patients. Respir Care. 2003;48(1):24-8.\u003c/li\u003e\n \u003cli\u003eArens R, Gozal D, Omlin KJ, Vega J, Boyd KP, Keens TG, Woo MS. Comparison of high frequency chest compression and conventional chest physiotherapy in hospitalized patients with cystic fibrosis. Am J Respir Crit Care Med. 1994;150(4):1154-7.\u003c/li\u003e\n \u003cli\u003eDarbee JC, Kanga JF, Ohtake PJ. Physiologic evidence for high-frequency chest wall oscillation and positive expiratory pressure breathing in hospitalized subjects with cystic fibrosis. Phys Ther. 2005;85(12):1278-89.\u003c/li\u003e\n \u003cli\u003eBraggion C, Cappelletti LM, Cornacchia M, Zanolla L, Mastella G. Short-term effects of three chest physiotherapy regimens in patients hospitalized for pulmonary exacerbations of cystic fibrosis: a cross-over randomized study. Pediatr Pulmonol. 1995;19(1):16-22.\u003c/li\u003e\n \u003cli\u003eHuang HP, Chen KH, Tsai CL, Chang WP, Chiu SY, Lin SR, Lin YH. 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. 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Gas exchange and ventilation-perfusion relationships in the lung. Eur Respir J. 2014;44(4):1023-41.\u003c/li\u003e\n \u003cli\u003eStoller JK, Heuer AJ, Vines DL, Chatburn RL, Mireles-Cabodevila E. Egan\u0026apos;s Fundamentals of Respiratory Care-E-Book: Egan\u0026apos;s Fundamentals of Respiratory Care-E-Book: Elsevier Health Sciences; 2024.\u003c/li\u003e\n \u003cli\u003eChen YH, Yeh MC, Hu HC, Lee CS, Li LF, Chen NH, et al. Effects of Lung Expansion Therapy on Lung Function in Patients with Prolonged Mechanical Ventilation. Can Respir J. 2016;2016:5624315.\u003c/li\u003e\n \u003cli\u003eMacIntyre NR. Physiologic Effects of Noninvasive Ventilation. Respir Care. 2019;64(6):617-28.\u003c/li\u003e\n \u003cli\u003eTromans AM, Mecci M, Barrett FH, Ward TA, Grundy DJ. The use of the BiPAP biphasic positive airway pressure system in acute spinal cord injury. 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Am J Respir Crit Care Med. 2001;163(1):283-91.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-pulmonary-medicine","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"pulm","sideBox":"Learn more about [BMC Pulmonary Medicine](http://bmcpulmmed.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/pulm/default.aspx","title":"BMC Pulmonary Medicine","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Pneumonia, high-frequency chest wall oscillation, intermittent positive pressure breathing, hospital days","lastPublishedDoi":"10.21203/rs.3.rs-4730848/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4730848/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground:\u003c/h2\u003e \u003cp\u003ePneumonia represents a significant global health burden with high morbidity and mortality rates, despite advances in therapeutic and preventive strategies. Airway clearance techniques (ACT), including High-Frequency Chest Wall Oscillation (HFCWO) and Intermittent Positive Pressure Breathing (IPPB), are critical in managing respiratory conditions. However, the combined effectiveness of IPPB and HFCWO in treating adult pneumonia remains underexplored.\u003c/p\u003e\u003ch2\u003eMethods:\u003c/h2\u003e \u003cp\u003eA retrospective cohort study was conducted at a college hospital in southern Taiwan, enrolling patients aged\u0026thinsp;\u0026ge;\u0026thinsp;18 years, admitted for pneumonia from January 2020 to December 2022, who received HFCWO therapy for \u0026ge;\u0026thinsp;5 days in the ordinary ward. Exclusion criteria included prior mechanical ventilation before HFCWO initiation. Univariate and multivariable logistic regression models were used to assess the effectiveness of the combined use of IPPB and HFCWO.\u003c/p\u003e\u003ch2\u003eResults:\u003c/h2\u003e \u003cp\u003eA total of 271 patients received HFCWO and were enrolled for analysis, including 163 patients who received both IPPB and HFCWO. Patients receiving both IPPB and HFCWO were associated with shortened total hospital stays (OR: 0.49, 95% CI: 0.28\u0026ndash;0.83, P\u0026thinsp;=\u0026thinsp;0.008), decreased frequency of sputum suction (OR: 2.91, 95% CI: 1.46\u0026ndash;5.78, P\u0026thinsp;=\u0026thinsp;0.002), and reduced oxygen need post-HFCWO (OR: 0.55, 95% CI: 0.33\u0026ndash;0.91, P\u0026thinsp;=\u0026thinsp;0.021). However, there was no difference in hospital stay post-HFCWO use, respiratory failure, ICU admission, or hospital death between the groups. Additionally, there was no difference in these outcomes for patients who received HFCWO twice daily compared to those who received it once daily.\u003c/p\u003e\u003ch2\u003eConclusions:\u003c/h2\u003e \u003cp\u003eCombining IPPB and HFCWO reduces the need for sputum suction and improves oxygen demand for patients but does not change hospital days, respiratory failure, or mortality. Further large prospective cohort studies are necessary to confirm the efficacy of this management approach.\u003c/p\u003e","manuscriptTitle":"Investigating the Effectiveness of Combining High-Frequency Chest Wall Oscillation with Intermittent Positive Pressure Breathing in Pneumonia Patients: A Retrospective Cohort Study Running head: Effectiveness of Combination of HFCWO and IPPB in Pneumonia","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-09-04 21:37:39","doi":"10.21203/rs.3.rs-4730848/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2024-07-31T19:22:37+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2024-07-31T10:21:46+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2024-07-31T10:21:27+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Pulmonary Medicine","date":"2024-07-12T14:07:39+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-pulmonary-medicine","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"pulm","sideBox":"Learn more about [BMC Pulmonary Medicine](http://bmcpulmmed.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/pulm/default.aspx","title":"BMC Pulmonary Medicine","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"d25ff52a-1d40-4a66-8b2d-439a405006a0","owner":[],"postedDate":"September 4th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2025-05-05T16:03:19+00:00","versionOfRecord":{"articleIdentity":"rs-4730848","link":"https://doi.org/10.1186/s12890-025-03685-y","journal":{"identity":"bmc-pulmonary-medicine","isVorOnly":false,"title":"BMC Pulmonary Medicine"},"publishedOn":"2025-05-03 15:57:34","publishedOnDateReadable":"May 3rd, 2025"},"versionCreatedAt":"2024-09-04 21:37:39","video":"","vorDoi":"10.1186/s12890-025-03685-y","vorDoiUrl":"https://doi.org/10.1186/s12890-025-03685-y","workflowStages":[]},"version":"v1","identity":"rs-4730848","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4730848","identity":"rs-4730848","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}