The Science Journal of the American Association for Respiratory Care

2009 OPEN FORUM Abstracts

THE USE OF A PROGRESSIVE PULMONARY PROTOCOL IN AN ONCOLOGIC INTENSIVE CARE UNIT

Laura G. Withers, Clarence G. Finch, Kristen J. Price, Quan M. Nguyen; Respiratory Care and Critical Care, The University of Texas MD Anderson Cancer Center, Houston, TX

Expanding the lungs and facilitating the removal of secretions have been proven to help prevent pulmonary complications arising during the post-operative period and those arising from immobility. In order to prevent lung complications, the importance of prophylactic and therapeutic respiratory modalities must be emphasized and utilized. EZ-PAP®, Acapella®, IPV, Metaneb®, and the Vest® are effective devices for mobilizing secretions and improving lung function. These modalities were used with a systematic approach to prevent and treat pulmonary complications arising in our ICU patient population. A progressive pulmonary protocol, that is patient driven, was initiated to minimize pulmonary complications in the ICU. Method: Upon patient admission to the ICU, or immediately following extubation, all non-ambulatory patients received EZ-PAP® and Acapella® QID, administered by the Respiratory Care Practitioner (RCP). The RCP performed a thorough patient assessment, including chest x-ray review and laboratory data, every shift and noted their findings. If any symptoms were present (see table below) during the patient’s stay in the ICU, the treatment plan was advanced to Plan A) IPV orMetaneb® every 4 hours, or Plan B) the Vest® with EZ-PAP® every 4 hours. When selecting option A or B, the RCP considered the preferences of the patient along with which treatment plan would provide the greatest benefit to the patient. Once the patient had complete resolution of noted symptoms, as documented by chest x-ray and/or Fi02, the patient was graduated to EZ-PAP® and Acapella® treatments QID. If the patient remained symptom free for 72 hours, the frequency of the EZ-PAP® and Acapella® was decreased to BID. Results: The successful implementation of this pulmonary protocol within the ICU setting showed improvement in chest radiography (CXR) post therapy. Conclusions: Further studies to evaluate the protocol impact on ICU length of stay are warranted. Sponsored Research - None

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