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