2000 OPEN FORUM Abstracts
UTILIZATION OF HIGH FREQUENCY CHEST WALL OSCILLATION (Vest Therapy) DURING THERAPEUTIC PEDIATRIC FLEXIBLE FIBEROPTIC BRONCHOSCOPY
Ann Gomez RCP, Ph.D., Isabelo Elisan RPFT, Karen Hardy MD; Children's Hospital Oakland, Oakland, CA
INTRODUCTION: Flexible bronchoscopy was first described in infants and children in 1978. The indications for flexible bronchoscopy are extensive. And in the hands of well-trained physicians the procedure is a safe and effective tool for the exploration of the pediatric airway. Indications for use include diagnostic and management of inflammatory, infectious and malignant disorders of the chest. Removal of secretions and bronchial alveolar lavage often produces approximately a 50% return. We were interested in a method to increase clearance.
CASE SERIES: We present a case series of three patients where video flexible bronchoscopy was done with a 3.0 size bronchoscope. Patient one was a 16-year-old male with Ducheene's Muscular Dystrophy involving respiratory failure from severe respiratory muscle weakness, reduced lung compliance and retained secretions. Bronchoscopy was performed as a follow-up to previous respiratory arrest due to mucus plugging. Patient two was a 9-year-old child with severe cerebral palsy following non-accidental trauma and asphyxia as an infant. Bronchoscopy was performed because of persistent atelectasis and to evaluate the airway for tracheobronchitis. We collected specimen for testing. Patient three was a 15-month-old child with cystic fibrosis. Bronchoscopy was done for lavage to determine if Pseudomonas was present. We collected specimen for testing. Vest Therapy was used in each flexible bronchoscopy to enhance mobilization of distal airway secretions.
FINDINGS: Patient one a 3.0 bronchoscope was introduced through a 5.5-tracheostomy tube. During Vest therapy (Pressure of 3, Hertz 13) application there was visualization of distal airway secretions that were mobilized to the bronchoscope for suctioning. There was no airway trauma from the oscillation of the VEST. Patient two a 3.0 bronchoscope was introduced through the patients left nostril through to the distal airways after Vest therapy |(Pressure of 3, Hertz of 13) was utilized for approximately two minutes. Bronchoscope was advanced to the left lower lobe secretions were easily aspirated with VEST Therapy. With bronchoscope in place it was noted, mild pink-tinged secretions were coming from above. VEST therapy was stopped. Hemoptysis was not coming from any visible lesion, but generally present in the carinal area. Evaluation flowing lavage showed no bleeding sites. There was minimal inflammatory change at the base of the glottis at the removal of the bronchoscope. Patient three a 3.0 bronchoscope was introduced through a 4.0 endotracheal tube. VEST Therapy was started (pressure of 3 Hertz of 13). Distal airways viewed and secretions obtained for sampling. There was no evidence of airway trauma.
CONCLUSION: Two of the three patients had improved secretion clearance with high frequency chest wall oscillation during suctioning. This small series suggests a roll for VEST Therapy needs to be further defined but was safe in-patient with artificial airways.