0000019337 00000 n The device can be used in a number of other scenarios including those patients who have tracheostomies or patients who are ventilator dependent. If performing with an artificial airway, deflate the cuff slightly during therapy remembering to re-inflate after therapy is completed. (2020). (2020). Set the operational pressure (which controls the peak operational pressure) between 30-45. Additionally, the CoughAssist T70 incorporates a new feature called Cough-Trak, which gives patients the ability to synchronize the treatment with their own breathing pattern for optimal comfort, explained Eli Diacopoulos, VP, general manager, Home Respiratory for Philips. Pathology can be described as a respiratory disease that often progressed into pneumonia with bilateral ground-glass opacities. 495 0 obj <>/Filter/FlateDecode/ID[<1742E9C112FBC5499E861B44C2B66805><4050128B81A18744A2B46EC044BDCEFD>]/Index[472 38]/Info 471 0 R/Length 110/Prev 216860/Root 473 0 R/Size 510/Type/XRef/W[1 3 1]>>stream No The MetaNeb System may be used in appropriate patients with an indication for airway clearance and/or lung expansion therapy. 0000007907 00000 n Metaneb like IPV can be done via mouthpiece, artificial airway, and in-line with the ventilator. Attention: Not all products/options are available in all countries. 0000026667 00000 n As you percuss those secretions with the oscillation technology, that flow is disrupted across the surface area of the secretionthink of it as viscosityyoure almost beating the secretion up and making it more watery. Paul, MN 55126, PatientsImportance of Respiratory HealthManage My TherapyProductsPatient Stories, Healthcare ProfessionalsBreak the Vicious CycleManage My PatientsProductsVA Government Options, ResourcesVideo LibraryEducation OptionsReimbursement ServicesInsurance CoverageGlossary of Terms, About UsInnovation MilestonesOur VisionCustomer ServiceIn the NewsEvents, Privacy Policy | Terms of Use | HIPAA Notice of Privacy Practices. Continue on this for 2 minutes then encourage the patient to cough or huff cough. and can be impacted by environmental factors such as velocity and mechanism by which respiratory droplets are propelled from the source, the density of respiratory secretions, environmental factors such as temperature and humidity, and the ability of the pathogen to maintain infectivity over that distance2and therefore has the potential to become an aerosol or airborne. Efficacy of oscillation and lung expansion in reducing postoperative pulmonary complication. Set CPEP 10-30 based on patient tolerance. Well-designed studies are needed to distinguish which LE approach has the greatest potential to optimize patient care, clinical outcomes and cost savings. Retrieved from, https://www.hillrom.com/en/products/the-metaneb-system/, Ortiz-Pujols, S., Boschini, L. A., Klatt-Cromwell, C., Short, K. A., Hwang, J., Cairns, B. 0000026299 00000 n The material on this site may not be reproduced, distributed, transmitted, cached or otherwise used, except with the prior written permission of WTWH Media. hb```c````e`jab@ !G#b.S.KusL7X:b6K*}z:q[hG[jAH60mFl&@HGGZdx2+00OdZFUU5Ed83mePp'ຣ@ 3I The possible complications listed below: Over distention of air sucks (alveoli). al. Kacmarak, R., Stroller, J., Heuer,A. As with the MetaNeb, the SmartVests oscillations thin the mucus and then propel it to the larger airways where it can be expectorated or coughed out. J Am Coll Surg. Similar to the IPV, Metaneb employs the same type of High Frequency Oscillatory action. Pulmonary Complications in High-Risk Patients 2/26/2018 CHICAGO , Feb. 26, 2018 /PRNewswire/ -- A group of researchers have reported that aggressive treatment after surgery using the Hill-Rom MetaNeb System may reduce the incidence of post-operative pulmonary complications (PPCs) in high-risk surgical patients. Risk Assessment for and Strategies To Reduce Perioperative Pulmonary Complications for Patients Undergoing Noncardiothoracic Surgery: A Guideline from the American College of Physicians. Registered Respiratory Therapist with a diverse background in healthcare but a keen interest in trauma intensive care. 0000005309 00000 n 0000005870 00000 n The MetaNeb System is a device that delivers continuous highfrequency oscillation (CHFO) and positive expiratory pressure (CPEP) to facilitate pulmonary mucus clearance and provide lung expansion. endstream endobj startxref With the exception of standard airway clearance and lung expansion procedures, other components of the patients respiratory care regimen will remain the same as during the standard therapy period, however the CHANGE IN PRACTICE will incorporate the use/treatment with The MetaNeb System as an alternative to usual airway clearance and lung expansion procedures. 2 . 0 trailer <]/Prev 63883>> startxref 0 %%EOF 70 0 obj <>stream 10. DeviceTalks is a conversation among medical technology leaders. The MetaNeb is designed for use on a number of patient types from postsurgery patients, such as thoracic or cardiac patients, to patients with chronic conditions or diseases such as cystic fibrosis or COPD. Elderly patients and those with underlying conditions like hypertension, cardiovascular disease Hill-Rom reserves the right to make changes without notice in design, specifications and models. The purpose of this prospective randomized clinical trial is to evaluate three different types of hyperinflation respiratory therapies, Intermittent Positive Pr. Often, patients who need Metaneb therapy are also on non-invasive support. It contains 10 distinct measures: Speech Salivation Swallowing Handwriting Cutting food and handling utensils (with or without gastrostomy) Dressing and hygiene turning in bed and adjusting bed clothes Walking Breathing Climbing stairs These 10 parameters are scored on a scale of 0-4, based on the patients' ability to perform tasks. The All rights reserved. 0000024185 00000 n PURPOSE: The management of pulmonary complications of patients with chronic debilitation conditions such as cerebral palsy . %PDF-1.5 % All expected complications are typical in the post-operative cardiac patients and not unique to hyperinflation therapy. A new study suggests the device is having a real, measurable impact on recovery, especially for high-risk patients. hb```B eaq]w,y{9 Y :Y-P%?: - 0000010608 00000 n 0000001441 00000 n If done in line with ventilation then the clinician can leave fragment in the CHFO mode. System to a 50 psi oxygen source. 0000051450 00000 n doi:10.1016/j.chest . Chest high-frequency oscillatory treatment for severe atelectasis in a patient with toxic epidermal necrolysis. It delivers a rapidly repeating pulse of air alternately squeezing and releasing the upper bodyeach squeeze simulates a mini cough, which acts to loosen the mucus from the walls of the airways. The continuous mist helps hydrate secretions allowing for the facilitation of trapped sticky mucus. 27 44 189 0 obj <>/Filter/FlateDecode/ID[<087C52A1184D40B4B8A759C2FEB6BFAB>]/Index[165 49]/Info 164 0 R/Length 112/Prev 857759/Root 166 0 R/Size 214/Type/XRef/W[1 3 1]>>stream One each from columns A and B. 0000003482 00000 n Select two study versions to compare. Retrieved from. 2019;229(5):458-466. endstream endobj 166 0 obj <>>> endobj 167 0 obj <>/ExtGState<>/Font<>/ProcSet[/PDF/Text]/Properties<>/XObject<>>>/Rotate 0/TrimBox[0.0 0.0 648.0 864.0]/Type/Page>> endobj 168 0 obj <>stream Get in the know to get the most value out of your solution. document.getElementById( "ak_js_1" ).setAttribute( "value", ( new Date() ).getTime() ); This site uses Akismet to reduce spam. https://doi.org/10.1097/BCR.0b013e318257d83e. In Stage II, a CHANGE IN PRACTICE will be made and patients will receive standard care with the addition of therapy with The MetaNeb System. The MetaNeb System is indicated for mobilization of secretions, lung expansion therapy, the treatment and prevention of pulmonary atelectasis, and also has the ability to provide supplemental oxygen when used with compressed oxygen. The MetaNeb Systems simple connect and go design uses single patient use circuits that includes a mouthpiece and adaptors for a face mask, tracheostomy, and in-line ventilation. Please do not continue treatment with an empty medication cup as this can cause irritation. 0000003954 00000 n The MetaNeb System is indicated for the mobilization of secretions, lung expansion therapy, the treatment and prevention of pulmonary atelectasis, and has the ability to provide supplemental oxygen when used with compressed oxygen. View this study on Beta.ClinicalTrials.gov. Epub 2019 Jul 27. Device: MetaNeb System Detailed Description Post-operative pulmonary complications (PPC) are associated with significant excess morbidity, mortality and healthcare expenditure. Per CDC guidance to Infection Control, health care providers take airborne precautions when performing any aerosol-generating procedures in known or suspected COVID-19 patients.5When performing aerosol generating procedures: The MetaNeb System therapy along with other bronchial hygiene therapies, is an AGP. 12. At the same time, the nebulizer is running throughout the entire therapy session. 0000027969 00000 n (2006). Read our, ClinicalTrials.gov Identifier: NCT02627742, Interventional Learn how your comment data is processed. Patients who may benefit from IPV/Metaneb: This site uses Akismet to reduce spam. 2021 Hill-Rom Services PTE Ltd. ALL RIGHTS RESERVED. The 10-minute timeframe isnt arbitrary, since most nebulizer treatments run about that duration, Mellor noted. St. Paul, MN. And you take time to switch back and forth.. 0000011442 00000 n Background: Metaneb intrapulmonary percussive ventilation device is utilized in pediatric patients as an airway clearance therapy used to clear secretions and promote lung expansion. PEP (EzPAP, MetaNeb) is performed if patient is: Unable to perform IS-or- Not meeting incentive spirometry goal or Has persistent or severe atelectasis or Has poor oxygenation Induced deep breathing in patients with a tracheostomy Indications and frequency in the VEP - the RT will assess patient and assign them a RT Triage Score. Age 18 years Post-thoracic, -upper abdominal or -aortic surgery Open surgical procedure Incision at or above the umbilicus. When you take into account all of the different devices you have to have at the bedside, we really want to find the best value for our healthcare teams and the patient, and we really feel that we have combined all three therapies into one device that is simple to use and easy to use, has a great interface, and, from an effectiveness standpoint, is combining all these tried and true therapies into one simple package.. An albuterol dose can be added in conjunction. Like most modalities, Chest Physiotherapy is not only dependent on the practitioner performing it but the patients willingness to have it done and work with the practitioner. 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Health care providers must therefore take the same precautions5. 0000034614 00000 n You coach the patientthis is a spontaneously breathing patient who is coherent enough to walk through the therapy with youyou encourage on the deep breathing mode, the CPEP mode, you start them there and stay there for a couple of minutes, and then you switch over to that oscillatory mode, CHFOwhich starts to percuss in those recruited airways to bring up those secretions, while the nebulizer is running consistently, Mellor said. The device begins by offering continuous positive expiratory pressure (CPEP) therapy, which helps expand the lungs, and then seamlessly moving on to the secretion clearance part of the treatment, which the company refers to as continuous high frequency oscillation (CHFO) therapy, at regular intervals. Skarvan noted that in these cases it may be used as a preventative treatment to help keep hospital patientsincluding those who will be prone for long periods of timeclear of secretions and possible infections. The study will be conducted in two stages. 0000028659 00000 n . This presents challenges to the assignment of isolation categories because ofconflicting information and uncertainty about possible routes of transmission. It's events, podcasts, webinars and one-on-one exchanges of ideas & insights. Has any research been done with the Acapella or Aeobika used inline on a vent circuit with adapters? Mellor of Hill-Rom noted that ultimately its a question of finding a provider that offers a quality product and stands behind it. Learn more about the Center of Disease Control and Society (CDC) of Critical Care Medicine (SCCM) guidelines. Metaneb delivers aerosol treatment (saline, hypertonic saline, and/or albuterol) while oscillating the airways with continuous positive pressure. %%EOF hbbd```b``v /d-lW0yDy`DrEHQVV&@Z0; ArN2qL %1m 0000027320 00000 n ON. The MetaNeb System is an LE expansion modality that incorporates all the physiological effects of IPV while providing additional therapeutic advantages intended primarily to more effectively treat or prevent pulmonary atelectasis. The MetaNeb System combines lung expansion, secretion clearance, and aerosol delivery into a single integrated therapy sessionwithout having to switch between different devices. The MetaNeb System, by mobilizing mucous secretions and lung expansion, may have contributed to these clinical improvement, Huynh says. Critical Care Pulmonologists share their insights on using Oscillation & Lung Expansion (OLE) therapy with ventilated COVID-19 patients. Post-operative pulmonary complications (PPC) are associated with significant excess morbidity, mortality and healthcare expenditure. The Matter of Pressure- ETT Cuff Pressures, Catecholaminergic Polymorphic Ventricular Tachycardia: Recognize And Treat It Early, 4Ts versus 3Ls: heparin induced thrombocytopenia probability scoring, Docusate for Cerumen Impaction? Patients who may benefit from The MetaNeb System include those with pulmonary atelectasis or secretions associated with the following conditions: *Therapy times may differ depending on patient needs and ordered therapies. Indications would be worsening oxygenation, increasing FIO2 and/or PEEP, evidence of lung collapse or mucus plugging, and/or retained pulmonary secretions in the absence of an effective cough. Among the specific conditions that can see benefits are patients with neuromuscular diseases, ALS, or any illness that prevents them from adequately expectorating secretions, and who are at an increased risk for developing respiratory infections. Explore Hillrom's products and medical technologies across the health care industry. Therapy with the MetaNeb. 10 Minutes Total*: Alternating cycles of CPEP and CHFO combined with aerosol delivery helps maximize therapy effectiveness. %%EOF 27 0 obj <> endobj xref Youre really facilitating it in a physical and a physics type treatment delivering that oscillatory breath across the area of the secretion, thinning it down where it can be expectorated by the patient.. https://assets.hillrom.com/is/image/hillrom/MetaNeb_ai0444_0078_shadow?$recentlyViewedProducts$, /en/products/request-more-information/?Product_Inquiry_Type=More%20Information&I_am_most_interested_in=Non-Invasive%20Respiratory%20Therapy&Product_Name=MetaNeb_System, hillrom:care-category/non-invasive-respiratory-therapy, hillrom:sub-category/therapy-oscillation-lung-expansion,hillrom:care-setting/acute-care, https://www.hillrom.it/en/products/the-metaneb-system/#overview-0, https://www.hillrom.it/en/products/the-metaneb-system/#educationdocumentation-1, MetaNeb System Controller close-up, front facing, An older patient in a hospital bed receives therapy from the MetaNeb system, his clinician nearby, A clinician with a gloved hand adjusts a control knob on the MetaNeb System Controller, A clinician with a gloved hand adjusts the MetaNeb Circuit, patient in background, A clinician connects the MetaNeb system to administer therapy to a patient who has been intubated, A clinician with gloved hands connects the MetaNeb system for use with ventilation, A young patient in a hospital bed receives therapy from the MetaNeb system, with help from her clinician, Chronic Obstructive Pulmonary Disease (COPD), Patients who need Post Operative Airway Management, Patients who need Emergency Room Airway Management, Introduces continuous high-frequency oscillation (CHFO) therapy immediately after lungs have been expanded through continuous positive expiratory pressure (CPEP), Integrates aerosol delivery of medications for maximum efficiency. Please refer to this study by its ClinicalTrials.gov identifier (NCT number): NCT02627742. If performing by the mouthpiece, allow the patient to take a break and cough or huff cough. 0000002608 00000 n CPEP mode provides aerosol combined with continuous positive pressure helping with lung expansion. What is the Intrapulmonary Percussive Ventilation (IPV). In Stage I of the study, a retrospective review of medical records for post-surgical patients, who received STANDARD THERAPY as defined by current hospital and respiratory care department policies and procedures will be performed. interviewer says fair enough. We have designed our system to maximize the comfort and assure that it is easy to use, said Kathleen Skarvan, CEO of Electromed. The journey of care isnt over for patients once theyre wheeled out of the OR. Medical Design and Outsourcing. The use of nebulized medications, including albuterol, N-acetylcysteine, and dornase alfa, administered via the MetaNeb system was not directed by protocol. Although PPCs are an incompletely understood multifactorial syndrome, atelectasis is recognized as a critical component. As a result, the CoughAssist T70 is a more gentle, comfortable way to remove secretions, keeping airways clear longer than trached suction and with fewer complications, Diacopoulos said. The MetaNeb System Three therapies. (2020, March 2). A., & Jones, S. W. (2013). Hospitalized COVID-19 patients are often in need of respiratory support.1. Simplify Clinical Communication & Collaboration. Weighing only 9 lbs, the CoughAssist T70 is easily portable, and a detachable battery adds a new level of flexibility for patients and caregivers. After 2 minutes of CPEP, switch to CHFO mode at a lower frequency setting. Please remove one or more studies before adding more. While it has been used to treat more than 400 diseases and conditions, it is most commonly used to treat cystic fibrosis, cerebral palsy, quadriplegia conditions, ALS, COPD, and bronchiectasis. I Sh*t You Not, Adrenal Crisis: Early Recognition and Management Save Lives, Prehospital Management of Traumatic Brain Injury, Differentiating Peak and Plateau Pressures, Sodium Bicarbonate for cardiac arrest: Time to put it away. Between Metaneb and IPV there have been no studies to show significant differences. 0000007220 00000 n The MetaNeb System, offered by Hill-Rom, addresses post-surgical respiratory problems that can impair a patients recovery. Droplets are considered particles secreted from a patients respiratory tract that are no smaller than 5m in diameter and travel shorter distances (defined as 3ft) because they cannot stay suspended in air for long periods of time. Patients who may benefit from The MetaNeb System include those with pulmonary atelectasis or secretions associated with the following conditions: *Therapy times may differ depending on patient needs and ordered therapies. Huynh, Toan; Cereda, Maurizio; Diette, Gregory; Liesching, Timothy Explore Hillrom's products and medical technologies across the health care industry. Philips Respironics also has clinical experts available for in-service training sessions, as well as product support for clinicians and patients. And then youre able to loosen it and bring it up through the airway. With the MetaNeb, you can seamlessly switch between recruiting an expansion of the lung, which is ultimately what patients need, to take a deep breath, through CPEP, and transition over to CHFO and pull those secretions from that expanded air space and clear their lungs, Mellor said. 0 The MetaNeb is designed for use on a number of patient types from postsurgery patients, such as thoracic or cardiac patients, to patients with chronic conditions or diseases such as cystic fibrosis or COPD. It consists of a pneumatic compressor that delivers OLE therapy using both continuous high-frequency oscillation (CHFO) and continuous positive expiratory pressure (CPEP). (2020). The guidelines related to airborne precautions, provided by the CDC should be followed when delivering the therapy.5, Efficacy of Oscillation and Lung Expansion in Reducing Postoperative Pulmonary Complication, Learn how to reduce the length of stay for pneumonia patients. The MetaNeb System is indicated for mobilization of secretions, lung expansion therapy, the treatment and prevention of pulmonary atelectasis, and also has the ability to provide supplemental oxygen when used with compressed oxygen. View Product Details Contact a Respiratory Health representative for more information Call us at (800) 426-4224 or CHFO is the oscillatory mode sending pulsations into the airways. 0000029883 00000 n 0000001552 00000 n Read full description Request More Information Overview Education & Documentation Overview The device was put to the test in a study performed at the Robarts Research Institute, Western University, London, Ontario, and researchers found that the study subjects had improvements in increased mucus clearance, decreased cough frequency and breathlessness, and enhanced exercise tolerance. The therapy is well tolerated by stable patients and appears to offer an alternative in patients with chest wall compliance. MedTech 100 is a financial index calculated using the BIG100 companies covered in Save my name, email, and website in this browser for the next time I comment. The handheld, lightweight, easy-to-clean device has been available for about 1 years for use both clinically and at-home by patients. 0000004067 00000 n Intrapulmonary percussive ventilation (IPV) devices have been in use for more than 25 years and are used widely in the acute care, post-surgical, and homecare setting. However,SARS-CoV while still classified as a droplet, is estimated to travel anywhere from 6ft. The MetaNeb System has been shown to treat pneumonia, trauma, post-op, chronic respiratory conditions, and other conditions to improve respiratory status and reduce pulmonary complications. Unlike some other systems that clear mucus by oscillating the chest wall, the Aerobika is an oral device dependent on inhalation and exhalation. Such devices provide both LE and airway clearance therapy (ACT) for patients with obstructive and/or restrictive lung diseases and conditions. Higher. Nov 1, 2014 | Clinical, COPD, Cystic fibrosis, Monitoring & Treatment, Other Chronic Diseases, Therapy Devices |. 0000008718 00000 n This can be performed in quite a number of ways dependent upon the patient, the lobe that requires the therapy, and any contraindication that can prevent a certain method of therapy. The material on this site may not be reproduced, distributed, transmitted, cached or otherwise used, except with the prior written permission of WTWH Media LLC. hVn6l1d'R$E[`Z.`$*Dq~w&:$:>E,b|qO4A3 The Medical Device Business Journal. Monaghan Medical Corps Aerobika Oscillating Positive Expiratory Pressure (OPEP) Therapy System device is a handheld device that provides intermittent resistance, positive pressure, and oscillation simultaneously, helping to move and assist mucus clearance into the upper airways, so it can be coughed out. Subscribe to Medical Design & Outsourcing. Would love your thoughts, please comment. Metaneb has a fixed orifice while IPV has a sliding venturi which facilitates the oscillations. 17: TREATMENT WITH METANEB THERAPY REDUCES POSTOPERATIVE PULMONARY COMPLICATIONS: A MULTICENTER TRIAL. %PDF-1.6 % CHFO. Philips Respironics CoughAssist T70 is a second-generation manual insufflator/exsufflator, which the company introduced to the market approximately 1 years ago. In studies of These therapies carry similar risk of airborne transmission. https://doi.org/10.1148/radiol.2020200236, https://www.cdc.gov/infectioncontrol/guidelines/isolation/index.html, https://www.imperial.ac.uk/media/imperial-college/medicine/sph/ide/gida-fellowships/Imperial-College-COVID19-NPI-modelling-16-03-2020.pdf, https://doi.org/10.1016/S0140-6736(20)30183-5, https://www.cdc.gov/coronavirus/2019-ncov/infection-control/control-recommendations.html, Wear appropriate personal protective equipment (PPE) including, but not limited to an N95 fit tested respirator, gown, gloves, and face shield/eye protection, Follow cleaning and disinfection procedures promptly in guidance with hospitals protocols, Refer to facility specific Infection Control guidelines for full recommendations. The treatment protocol used for Respiratory Care during the CHANGE IN PRACTICE period of the Study will be that prescribed by the patient's health care team in the routine standard care of each patient. TM. Accept Read More. Learn more about MetaNeb System. OLE therapy delivered by The MetaNeb System helps expand the lungs and mobilize secretions using Continuous Positive Expiratory Pressure (CPEP), and Continuous High Frequency Oscillation (CHFO). Please check availability with your local Hillrom representative or click on Request More Information to contact Hillrom customer service. Today, respiratory therapists have a plethora of devices to choose from; but while their size, complexity, and the way they perform their vital treatments may vary, they all help to mobilize secretions and clear the airway and lungs. mitigate complications associated with secretion retention. 11. All Rights Reserved. 0000021670 00000 n An effective and efficient solution. If the SmartVest is prescribed for home use, a trainer will be sent to the patients home to help them be fit with the device and understand how it is used, and to calibrate it according to the prescribing physicians directions. Although PPCs are an incompletely understood multifactorial syndrome, atelectasis is recognized as a critical component. 0000023728 00000 n metaneb treatment on ventilator (-)should be ordered 6-8 times daily (1) remove blue selector ring & replace it with the black occlusion ring to make sure the exhalation orifice is blocked Earlier this year, the Aerobika received the Gold award at the Medical Design Excellence Awards (MDEA). After 20 minutes, or when the cup is empty, the treatment is complete. Expert Rev Respir Med. The MetaTherapy Treatment maximizes efficiency for patients and clinicians by combining lung expansion, secretion clearance and aerosol delivery into a single . The duration of the treatment is controlled by the therapist and level of patient tolerance. . A lung-expansion therapy, MetaNeb enhances mucus clearance and helps resolve or fully prevent patchy atelectasis. Early publications and reports on the clinical manifestations of COVID-19 suggest that up to 30 % of patients with severe disease have significant pulmonary mucus production.4Additionally, lung disease in many of these patients progresses to acute respiratory distress syndrome (ARDS). 2019 Nov;229(5):458-466.e1. Additional interests are ventilators, new innovations in healthcare, and traveling. The MetaNeb System is an LE expansion modality that incorporates all the physiological effects of IPV while providing additional therapeutic advantages intended primarily to more effectively treat or prevent pulmonary atelectasis. The device can be used in treating patients with a number of respiratory diseases and conditions, including cystic fibrosis and COPD. Learn how your comment data is processed. Pathology can be described as a respiratory disease that often progressed into pneumonia with bilateral ground-glass opacities. Interim Infection Prevention and Control Recommendations for Patients with Suspected or Confirmed Coronavirus Disease 2019 (COVID-19) in Healthcare Settings. As with all therapies, the appropriateness of the therapy in individual patients is determined by the treating physician and the health care team. Patients will receive standard care with the addition of therapy with The MetaNeb System. While oscillating technology is essential to secretion clearance, RTs and other clinicians have a number of options for the way it can be done, as the following representative devices from Hill-Rom, Philips Respironics, Electromed, and Monaghan Medical Corp illustrate. MedTech 100 is a financial index calculated using the BIG100 companies covered in The soft start helps people to better acclimate to the therapy so it doesnt give them an abrupt sharp hug, and the active inflate and deflate acclimates the patient to therapy by allowing the garment to contour to the chest cavity and the pulse amplitude remains more constant during the inhalation and exhalation so you dont have an uncomfortable bear hug..