2001 OPEN FORUM Abstracts
EzPAP?AN ALTERNATIVE IN LUNG EXPANSION THERAPY
BrianM. Daniel, RRT; Jeffrey L. Tarnow, RRT Moffitt/Long Hospitals
University of California, San Francisco
Background: Thereare a number of conventional therapies available to re-expand lung parenchymain patients with clinically diagnosed atelectasis (incentive spirometry, positioning,chest physiotherapy). Intermittent positive pressure breathing (IPPB) has beensuggested in cases where patients did not respond to, or could not cooperatewith other therapies. EzPAP? (Positive Airway Pressure Therapy System) mightbe alternative to IPPB in re-expanding atelectatic lung parenchyma. We therefore,observed eight patients in the Neuro- Intensive Care Unit who were ordered forlung expansion therapy. All patients had either unilateral or bilateral atelectasis.All were on supplemental oxygen of 100% via a facemask and a Misty Ox® highflow nebulizer. The mean oxygen saturations were 90+2%.
Methods: EzPAP?was administered every2-4 hours around the clock. Therapy was performedfirst by mouthpiece with supplemental oxygen; and if the patient?s saturationsfell below the pre-therapy level, EzPAP? was then administered by facemask withsupplemental oxygen. Oxygen flow was (via oxygen flowmeter), maintained to achievean expiratory pressure of 10-20 cmH2O.
Results: Afterbreathing 10 to 20 breaths on the EzPAP? system, oxygen saturation increasedto a mean of 94+2% in all patients. The mask was removed and the patientswere instructed to cough. This sequence was repeated 3 to 4 times. Of the patientsthat were observed, only one eventually required intubation, due to a changein mental status and unable to protect the airway.
Conclusion:Based upon the preliminary observational findings, EzPAP? may offer a safe,effective alternative lung expansion therapy in the treatment of atelectasisin critically ill patients. To truly establish a role for EzPAP? in this areaof respiratory care, further randomized studies will be needed.