The Science Journal of the American Association for Respiratory Care

2011 OPEN FORUM Abstracts


Cathy A. Hejl, Robert S. Trusty, Melissa M. Damas, Jon M. Langenfeld, Teresa Zustiak, William Wheeler, Michael Shreve; Respiratory Therapy, Childrens Hospitals and Clinics of Minnesota, Minneapolis, MN

Background: IPV was introduced in August 2010 with the Metaneb device. Diagnoses for patients treated included pneumonia with acute respiratory failure,bronchiolitis, and patients with innate mucociliary transport dysfunction. Methods and materials : Metaneb box,circuit adapters and valved tee for inline therapy. Policy and procedure was adapted to the use of an open entrainment ring on the circuit. In-vitro evaluation reflected this to be a safer choice to modulate delivered PIP, MAP during inline therapy. Full occlusion ring was employed on circuits on intubated patients with peep greater than 8 cm set. Results :75 patients,ages 4 weeks to 22 years were treated with invasive and non-invasive IPV therapy with Metaneb. 7 patients demonstrated intolerance by hemodynamic compromise or the inability to coordinate breathing mechanics. 5 patients were found to have positive ETT cultures after therapy started. Conclusions: MetaNeb therapy was found to be beneficial for patients in pediatric acute and critical care environment. 70% of patients treated demonstrated a significant improvement in CXR within 48 hours after staring therapy. Approximately 78 % of patients treated demonstrated a decrease in secretion burden after 24 hours of therapy. Our policy and procedure for administration of this therapy evolved from this evaluation. Patients with evidence of high airway resistance, or a disease process that demonstrated marked hyperinflation were not considered prime candidates for the therapy. Patients less than 2 years of age that required a mask interface for therapy are managed at a pediatric intensive care or intermediate care unit status. It was established in our policy and procedure to administer all medicated aerosolized therapy via ultrasonic therapy prior to the IPV therapy on in-line application of a MetaNeb treatment. Infection control standards developed included changing the small volume nebulizer cup every 24 hours, if the SVN cup was utilized. The MetaNeb circuit is changed every 3 days. The cleansing of any contact connections of the MetaNeb circuit and ventilator adapters and valved "tee" with Choraprep antiseptic wipes for 30 seconds prior to the introduction of the MetaNeb circuit into the ventilator circuit was mandated for in-line application. Sponsored Research - None