1999 OPEN FORUM Abstracts

UTILIZING KINETIC AND PERCUSSIVE THERAPIES TO IMPROVE PULMONARY OUTCOMES OF A PEDIATRIC PATIENT: A Case Study.

Theresa Ryan Schultz, BA, RRT, CPFT, P/P Spec., Roberta Hales, BS, RRT, P/P Spec., Ann Marie Wallack, AS, RRT, P/P Spec., Kathleen Sloan, BS, RRT, P/P Spec., Denise Garvey, AS, CRT, P/P Spec., Mark Helfaer, MD. The Children's Hospital of Philadelphia, Philadelphia, PA.

A 5 mos. old with a history of Hemophagocytic Syndrome was admitted to the PICU in respiratory distress requiring 60% oxygen via tent. She was tachypneic with a respiratory rate of 145, and tachycardic to 176. Within two days of this ICU admission, the patient became acidotic and hypoxic, requiring nasal tracheal intubation. PaO₂/FiO₂ (P/F) one hour post intubation and mechanical ventilation was 64. This patient received a Bone Marrow Transplant on the third day of this ICU admission. After eleven days of mechanical ventilation, the patient was weaned to extubation. Negative inspiratory force was -50 cm H₂0 prior to this brief trial. This patient was re-intubated with 3.5 mm tracheal tube secondary to extrathoracic gasway obstruction. One day post re-intubation this patient's P/F remained <250 (233). She progressively deteriorated over the next few days requiring volume replacement for hemodynamic instability. Chest x-ray eventually revealed worsening of fluffy infiltrates/nodules. Follow-up CT Scan showed complete atelectasis of the left lung with mediastinal shift towards the left and right scattered pulmonary nodules. Amphotericin was started for a presumed fungal infection. Fluids and dopamine were administered for continued periods of cardiovascular instability. Pulmonary toilet with manual bilateral rotation and percussion followed by suction was done every 2-4 hours. In spite of these efforts this patient's P/F fell to 183 over the next few days. It was decided that this patient might benefit from the kinetic and percussive therapies available on the KCI PediDyne Crib¹. The patient was transitioned to this crib without incident. Continuous lateral rotation/kinetic therapy @ 30-40 degrees with percussion every 4 hours were the therapies utilized. Within twenty-four hours of receiving these therapies, the patient's P/F increased to 209. There were no other changes in ventilating pressures or minute ventilation. Within 72 hours of initiating therapy, this patient's P/F increased to 251. By the 90th hour of therapy, the P/F increased to 366. The patient then began to wean from the mechanical ventilator and was successfully extubated to a 2 liters per minute nasal cannula 4 days later. Chest radiograph showed no focal radiodensities at this point in time. She was transferred out of the ICU one day after successful extubation.

Conclusion: Kinetic and Percussive Therapies available on the PediDyne Crib seemed to be a valuable adjunct to this patient's course of treatment. For these reasons, we have developed a prospective crossover design study to investigate this objectively.

1. McKay C. A Supplement to RN. Best Practices: Reducing nosocomial pneumonia. Feb. 1999.

OF-99-049