The Science Journal of the American Association for Respiratory Care

2008 OPEN FORUM Abstracts

HIGH FREQUENCY CHEST WALL OSCILLATION INCREASES SECRETION CLEARANCE AND CHEST RADIOGRAPH IN A PATIENT WITH TRAUMATIC BRAIN INJURY, A CASE STUDY.

Matthew Davis1, Thelma Harrington1, Deb Stein1, Carl Shanholtz1



Introduction: A patient was admitted with traumatic brain injury (TBI) and multiple fractures after being struck by a car and sustaining head injury with loss of consciousness.

Summary: On admission APACHE II score was 22, Injury Severity Score (ISS) was 33, the hospitalization course was complicated by abdominal compartment syndrome, ARDS, MRSA pneumonia, right lower extremity DVT, and rhabdomyolysis.
Patient was placed on mechanical ventilation after admission. TBI was managed with an intraventricular catheter and brain tissue oxygenation (PtiO2) was monitored.
Patient was placed erect on a tilt table due to low cerebral perfusion pressure (CPP) and high intra cranial pressure (ICP), which made it difficult to perform traditional chest physiotherapy. Recumbent positioning caused a sharp decrease in CPP. Radiographic progression of infiltrates and pulmonary physiologic deterioration compelled alternative means for secretion clearance with high frequency chest wall oscillation (HFCWO). HFCWO was initiated on hospital day four at a two hour frequency. HFCWO frequency progressed to twenty minute intervals followed by twenty minute breaks to protect skin integrity and maintained for four consecutive days.

Discussion: There was substantial radiographic improvement and mechanical ventilation was weaned during the four days of frequent HFCWO. Respiratory therapists subjectively recorded notable increases in secretion volume cleared during and after HFCWO. Secretion clearance with HFCWO was associated with radiographic and physiologic improvement and alleviated safety concerns over conventional chest physiotherapy in this case of TBI.