The Science Journal of the American Association for Respiratory Care

2006 OPEN FORUM Abstracts

A CASE STUDY:  THE USE OF METANEB TO IMPROVE SECRETION REMOVAL AND REVERSE ATELECTASIS

           

Michael Bocci, RRT, Juan A. Garcia, MD, Brian Timon BS, RRT,  
Raymond Wolff Jr., RRT, Ken Hargett BS, RRT, Charles Thornton, CRT,  
The Methodist Hospital, Respiratory Care Services, Houston, TX. 

Introduction: Pneumatic chest physiotherapy (PCPT) is a proven treatment in managing bronchial hygiene.  It is routinely utilized in our continuum of care for bronchial hygiene. The MetaNebTM (Comedica Incorporated) is a newly designed PCPT device that employs a methodical approach in the augmentation of secretion clearance, prevention or reversal of atelectasis, and reduction of air trapping. The MetaNebTM presents two modes of therapy: continuous positive expiratory pressure (CPEP) and continuous high frequency oscillation (CHFO). CPEP delivers aerosolized medication with a constant pressure during both inhalation and exhalation. CHFO delivers aerosolized medication, maintains a viable mean airway pressure, and oscillates during inspiration and exhalation at a calibrated frequency established by the manufacturer. This blending of treatment modalities enhances normal mucus clearance and assists in resolving atelectasis.

Case Summary:
  The patient is an eighty (80)  year- old, white male that is post operative for thoracoscopic surgery, which included bleb resection from the left lower, upper, and lingula lobes, followed by mechanical pleurodesis and the insertion of several chest tubes. Patient has an extensive pulmonary history that includes COPD, hypertension, CHF (congestive heart failure) and recurrent pneumothoraces. Patient was liberated from mechanical ventilation and supplemental oxygen was administered via nasal cannula at 6Lpm. Later on the patient developed subcutaneous emphysema. Breath sounds diminished and SpO2 decreased to 84%. High flow oxygen therapy was initiated and SpO2 increased to 93%. Chest x-ray revealed increased infiltrates at the lung bases and pronounced left lung volume loss.  CHFO therapy with bronchodilators was administered every 4 hours via the MetaNebTM. During the treatments, the patient expectorated large amounts of tenacious secretions. Within 8 hours of initiation of therapy and after only two treatment sessions, improvement in breath sounds by auscultation was noted, supplemental oxygen decreased to 6 Lpm while maintaining  SpO2 of 97-100%. Ensuing chest x-rays revealed improved aeration with patchy infiltrates and pleural thickening of the left hemi thorax, due in part to the pleurodesis. CHFO bronchial hygiene therapy was continued for the duration of the patient's stay in the ICU. A progressive improvement in the patient's pulmonary status was documented.

Discussion:
  The MetaNebTM PCPT is an effective bronchial hygiene tool. It has demonstrated the ability to deliver effective bronchial hygiene without complications for a patient post thoracoscopic surgery that had suffered from recurrent pneumothoraces and numerous pulmonary maladies. We have added the MetaNebTM to our clinical treatment continuum for lung clearance. From this case study and many other similar successful cases, we currently have expanded the use of the MetaNebTM to all of our ICUs and major patient care areas.

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