2001 OPEN FORUM Abstracts
ABI Vest Airway Clearance System Used During Bilateral Therapeutic Whole Lung Lavage for the Treatment of Pulmonary Alveolar Proteinosis
DavisJ., RRT, Popvich, M., MD The Cleveland Clinic Foundation, Cleveland, Ohio
Background: Pulmonaryalveolar proteinosis (PAP) is a rare disorder in which deposition of lipoproteinaceousmaterial leads to progressie respiratory distress. Bilateral therapeutic wholelung lavage (BTWLL), which involves installation of large volumes of normalsaline into the lung facilitated by double lumen endotracheal intubation, onelung ventilation, and general anesthesia, has been an accepted treatment forsystomatic relief of patients with PAP. During BTWLL, manual or hand-held pneumaticpercussion to the chest wall is conventionally applied to assist in mobilizationof the saline and removal of the proteinaceous sediment. We theorized that theABI Vest Airway Clearance System, a novel total ches wall oscillation technique,might help improve efficacy of BTWLL.
Method: A 43 year old malepresented to our institution for BTWLL. Prior to induction of anesthesia, hewas fitted with the ABI Vest and educated about the rationale of total chestwall oscillation. BTWLL was performed serially via a #39 left endobronchialtube with 5 liters of warmed saline solution per lung, lavaged in 0.5-1 litersaliquots. Throughout the procedure the ABI Vest was inflated and oscillatedthe chest wall in 15 minute increments with 5 minute pauses. Oscillation wascontinued after the procedure in the PACU. The patient was allowed to recoverfor 2 hours, then was extubated. He was weaned to nasal oxygen and transferredto a regular nursing hospital room within 5 hours post-procedure.
Discussion: The ABI VestAirway Clearance System prermitted more efficient percussion as compared tothe standard manual or pneumatic hand-held technique. Total chest wall oscillationhelped to uniformly mobilize saline andproteinaceous sediment wheras the manualmethod or use of a pneumatic hand-held device can only apply percussion to alocalized area. Because the ABI Vest also provided posterior oscillation, thepatient did not have to be subjected to the inherent risks of repositioningthat would have been necessary to administer conventinal percussion. In addition,the ABI Vest considerably reduced the intensive attention to manual percussionby the respiratory therapist, while provideing improved overall chest wall oscillation.
Conclusion: TheABI Vest Airway Clearance System is a viable alternative to manual or pheumaticchest percussion durint BTWLL in the treatment of PAP.