2004 OPEN FORUM Abstracts
PILOTSTUDY:PERCUSSIVE NEBULIZER VS. TRADITIONAL BRONCHIAL HYGIENE THERAPY FOR TREATMENT OF POST OPERATIVE ATELECTASIS IN CARDIAC SURGERY PATIENTS
John
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.