Bronchial Hygiene: Why So Important?
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Transcript Bronchial Hygiene: Why So Important?
Normal
HFCWO
HFCWC
Intrapulmonary
Percussive
Case Report
7/14-8/3/2011
21 year old female admitted with acute
respiratory failure requiring mechanical
ventilation
Received lung transplant prior year
Developed failure to thrive and acute on
chronic hypercarbic respiratory failure
Past medical history of bronchopulmonary
dysplasia, asthma, DVT, and
immunosuppresant therapy
Case Report
7/14-8/3/2011
Prior to intubation FVC was reduced from
baseline 600-700 cc to 300cc.
Baseline PaCO2 70 mm Hg and had risen to
124 despite optimal mechanical ventilation.
Case Report
7/14-8/3/2011
Pressure/Volume curve obtained to assess
potential for lung recruitability.
High recruitability
(Increased PV Hysteresis)
Our Patient
Minimal PV Hysteresis)
Case Report
7/14-8/3/2011
Tracheal Gas Insufflation (TGI)
initiated to decrease PaCO2
which had risen to >129.
7Lpm
Pre TGI
Post TGI
pH
7.18
7.25
PaCO2
129
97
Case Report
7/14-8/3/2011
Heliox initiated to further facilitate
improving PaCO2 and minimize AutoPEEP,
however several trials failed due to hypoxia.
Chest X-ray had obviously worsened.
Case Report
7/14-8/3/2011
During 2nd day of MetaNeb in-services and
we suggested the use of MetaNeb to
pulmonary intensivist for secretion
clearance.
Although initially reluctant, MD agreed.
CHFO mode was used to deliver 10-20 cc of
Normal Saline Q4.
CXR Improvement
7/19/2011
7/20/2011
Physician Notes 24 later
Case Report
7/14-8/3/2011
Patient survived hospital stay and was
extubated several days later.
Recently received her second lung transplant
(for a total of 3 sets of lungs she has
possessed).
Patient is doing fine
Even more important, the therapy left a
lasting impression with the physician.
In Summary
1.
RT Protocolized BHT approaches are better than
Physician directed therapies.
2.
Do not underestimate the benefits of optimal
humidified O2 delivery & hydration
3.
Conventional CPT is subpar at best. Don’t
default to it because of an inability to evolve
4.
Consider High Frequency devices
5.
Individualize Patient Care