2004 OPEN FORUM Abstracts
PILOTSTUDY:PERCUSSIVE NEBULIZER VS. TRADITIONAL BRONCHIAL HYGIENE THERAPY FOR TREATMENT OF POST OPERATIVE ATELECTASIS IN CARDIAC SURGERY PATIENTS
Garcia, RRT, Kasem Loui, RRT, NPS, Luis Moreta-Sainz, MD Kaiser Permanente Los
Angeles Medical Center, Los Angeles, CA
BACKGROUND: Kaiser Permanente Los Angeles Medical Center is the regional tertiary care center for cardiac surgery. A well known complication of cardiac surgery is post-operative atelectasis. The traditional bronchial hygiene therapy approach to post-operative atelectasis includes intermittent positive pressure breathing (IPPB) treatments followed by chest physiotherapy (CPT). Traditional therapy is extremely labor intensive and has in our experience demonstrated marginal clinical efficacy. Moreover, the traditional bronchial approaches to post-operative atelectasis are inconsistent with our evidence based practice model. Therefore a pilot study was conducted utilizing a disposable single patient use percussive nebulizer (PN).
METHOD: 26 post-operative cardiac surgery patients who met our treatment criteria for post-operative atelectasis were placed on PN therapy and evaluated: Our treatment criteria for both groups included: increasing fiO2 requirements, ABG demonstrating hypoxemia and/or hypercarbia with or without acidosis, and chest x-rays (CXR) showing atelectasis or infiltrates. Clinical improvement was defined as: clearing or improved CXR, and a decreasing fiO2 requirement with an average fiO2 of .25 and SpO2 of 96%.
RESULTS: All 26 patients in the PN group presented with atelectasis on CXR and were receiving high levels supplemental oxygen with an average fiO2 of .60 pre PN therapy. Of these patients, 24 showed clinical improvement in an average of 3 days. There were two PN treatment failures, one due to late intervention and another due to cardiac failure. Both patients required reintubation and mechanical ventilation.
EXPERIENCE: PN appears to be a viable alternative to our traditional bronchial hygiene regimen though a more thorough investigation should be undertaken.
CONCLUSIONS: Treatment of atelectasis in post-operative cardiac surgery patients with PN appears to be a more effective and efficient use of departmental resources than traditional bronchial hygiene procedures.