2005 OPEN FORUM Abstracts
USE OF THE VESTT AS AN ALTERNATIVE TO MANUAL POSTURAL DRAINAGE THERAPY IN A MEDICAL ICU (MICU) AND A POST INTENSIVE CARE REHABILITATION UNIT (PICRU)
AUTHORS: Kathleen Spihlman, AS, RRT, RCP; Cheryl Hoerr, BS, RRT, CPFT, RCP; Stephen Lefrak, MD; Barnes-Jewish Hospital, St. Louis, MO
BACKGROUND: Postural Drainage Therapy (PDT) has been used for decades to improve the mobilization of bronchial secretions, and to treat atelectasis caused by mucus plugging. However, there is limited scientific evidence regarding effectiveness of the traditional method of hand clapping or vibration. The MICU and the PICRU treat adult patients that are not ideal candidates for traditional PDT due to the presence of artificial airways, mechanical ventilatory support, and neuromuscular complications, making positioning difficult. Respiratory Therapists are experiencing increasing work related injuries such as back strain and repetitive motion injuries related to providing traditional PDT.
METHOD: The Respiratory Team Leader and the Medical Director of the PICRU decided to evaluate The VestT as an alternate method of PDT. The VestT does not require patients to be placed in traditional PDT positions to be effective, and is easier to use on difficult to position patients. The Respiratory Team Leader gathered data on 11 randomly selected patients receiving The VestT therapy in the MICU and the PICRU. All patients were on mechanical ventilatory support, had artificial airways in place, and were treated by the same team of Respiratory Therapists. The VestT therapy was initiated for 10 minutes QID, pressure and frequency were adjusted to patient tolerance. The VestT was not used on patients with platelet counts less than 30,000 or patients who were post-op spinal fusion or spinal anesthesia. Patients with consolidation were treated with antibiotic therapy in addition to The VestT. Six patients were converted from traditional PDT to The VestT when it became evident that traditional PDT was ineffective; the remaining five patients did not receive PDT before receiving The VestT therapy. Mean patient age: 45.6 years. Gender: 5 females, 6 males. Indications for therapy: bronchiectasis (1), mucus plugging/consolidation (3), neuromuscular disease with consolidation (6), cystic fibrosis (1). Three patients had a history of tobacco abuse.
RESULTS: All patients were able to better tolerate The VestT therapy over traditional PDT because they did not have to be placed in Tredelenberg positions. Therapists found The VestT easier to use due to ease of patient positioning and decreased physical strain. All patients exhibited increased secretion mobilization while receiving therapy; suctioning requirements decreased from Q1 hour to Q4 after 48 hours of The VestT therapy. Patients with consolidation demonstrated a more rapid lobar re-expansion with The VestT (within 24 hours, documented by chest x-ray) versus traditional PDT. There were no adverse effects associated with providing therapy with The VestT.
CONCLUSION: The VestT therapy is a viable and effective therapy alternative to traditional PDT in this patient population. It is not position dependent and can be used when patient positioning and cooperation are problematic, such as ventilated patients, patients with indwelling catheters, patients with neuromuscular conditions. The VestT allows more uniform delivery of therapy.