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Vest Therapy (High Frequency Chest Wall Oscillation)

What is Vest Therapy? (High Frequency Chest Wall Oscillation)

The “vest” is a machine that is made up of two parts: an air-pulse generator and an inflatable vest that wraps all they way around the chest. The air pulse generator creates rapid bursts of air that make the vest inflate and deflate against the chest wall.

The vibration of the vest against the chest wall helps to loosen mucus. The vest creates an airflow that helps to remove mucus from the airway walls. For therapy to be effective, Huff Cough and regular coughing must be done during and after the treatments.

Perform vest treatments two times a day: Once in the morning and then again in the afternoon or evening. Increase vest treatments to four times a day when your child is sick (or feels they may be getting sick). Medicine that may be given during vest treatments include Albuterol, Atrovent, Intal, Pulmozyme and hypertonic saline.

Preparing to Use the Vest

  • Put the vest on over a thin layer of clothing
  • Adjust the shoulder straps so that the vest covers as much of the upper chest as possible (but without digging into your child's armpits)
  • The bottom of the vest should extend to just above the hip bones
  • Adjust the closure clasps. When your child takes in a deep breath, a hand should fit comfortably between the chest and the vest
  • As the vest inflates, grab the bottom of the vest with both hands and pull down. This will prevent the vest from sliding up and digging into your child's armpits
  • Instructions to Use the Vest

    Follow the prescribed vest protocol treatment. The two most common are the Standard Protocol and Minnesota Protocol. The Standard protocol can be used with the following vest machines: Hill-Rom Model 104, In-Courage System by Respir-Tech, and the Smart Vest.

    Standard Protocol:

    There will be four cycles of treatment. Each cycle has its own settings. Make the following settings on the machine for each cycle:

    1st cycle of treatment 2nd cycle of treatment 3rd cycle of treatment 4th cycle of treatment
    Frequency = 11 Hz
    Pressure = 6
    Time = 6 minutes
    Frequency = 12 Hz
    Pressure = 6
    Time = 6 minutes
    Frequency = 13 Hz
    Pressure = 6
    Time = 6 minutes
    Frequency = 14 Hz
    Pressure = 6
    Time = 6 minutes
    Note: Some vest machines will display pressures as a single, double, or in a percentage. (6, 60, or 60%)


    1. Confirm correct settings on machine
    2. Press the ON button (or foot pedal) to begin treatment.
    3. After six minutes of treatment (one cycle), pause the vest generator to deflate the vest (if the vest does not deflate disconnect one end of one of the hoses).
    4. Perform two or three sets of Huff Coughs to remove the mucus from your child's lungs.
    5. Repeat Steps 1-4 for remaining cycles.


    • To avoid problems with your child's stomach, try to do vest treatments before meals or no sooner than one hour after meals.
    • Some patients find it helpful to moisten their airway secretions. This is done by taking nebulizer treatments with normal or hypertonic saline after other medicines are complete.
    • If itching occurs, try a couple of cotton T-shirts between the skin and the vest.
    • Have the vest machine and inflatable vest checked each year. This is needed to ensure it is working properly and that your child has the correct vest size.

    Cleaning the Vest

    • Keep your vest clean and free of mucus and other debris
    • Wipe it down with a disposable sanitizing cloth as needed

    Last Updated 02/2022

    Reviewed By Jen Gronauer, RT

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