2012 OPEN FORUM Abstracts
USE OF AIRWAY CLEARANCE TO TREAT CHRONIC ATELECTASIS IN A VENTILATOR DEPENDENT INFANT WITH CHRONIC LUNG DISEASE: A CASE REPORT.
Stephanie A. Bailes1, T. Jeffery Bulter2, Teresa A. Volsko1; 1Respiratory Care, Akron Childrens Hospital, Akron, OH; 2Neonatalogy, Akron Childrens Hospital, Akron, OH
BACKGROUND: Bronchopulmonary dysplasia (BPD) is chronic lung disease associated with chronic airways inflammation, reduced number of alveoli, impaired secretion mobilization and chronic atelectasis. Although airway clearance (ACT), is a commonly prescribed for this population, modalities are limited. CASE REPORT: An eight month- old medically complex female with BPD received albuterol MDI, 2 puffs with postural drainage and clapping (PD &C) every 3 hours in addition to ventilatory support for 30 days. Ventilator settings were PRVC/SIMV, tidal volume (VT) 45 mL, mandatory rate 30, PEEP 14 cm H2O, pressure support 17 H2O, inspiratory time 0.5 seconds, FIO2 .28. The patient was alert and oriented, with warm, pink and well perfused skin. An acute change in respiratory status occurred. Coarse crackles and decreased aeration bilaterally were noted. An increase in FIO2 to 67% was needed to maintain a SpO2 > 92%. Peak inspiratory pressures rose from 21-33 cm H2O to 45-59 cm H2O. Respirations ranged from 50-80 breaths per minute. Slight improvement in aeration was noted after 2 puffs of albuterol by MDI. A chest radiograph was ordered which revealed the distal end of the tracheostomy tube just below the clavicles and worsening atelectasis, Figure 1. Blood, urine and sputum cultures were obtained. The VT was increased to 50 mL, a longer custom tracheostomy tube was ordered and empiric antibiotics administered. Airway clearance therapy changed from PD&C to the Frequencer V2X every three hours. White Blood Count was 27.7 cells/mL/cu mm. Sputum cultures revealed moderate growth of pseudommas aeruginosa and stenotrophomonas (Xanthomanas) maltophilia. FIO2 and VT returned to baseline and tachypnea resolved within 48 hours of initiating the care plan change. Within seven days a custom tracheostomy tube was inserted and repeat chest radiograph obtained which revealed the distal end of the tracheostomy tube at T3-T4 and marked improvement in atelectasis. Radiographic findings remained unchanged for the next 6 weeks with the new ACT regimen. DISCUSSION: Patients with BPD may benefit from ACT and an evaluation of the ACT required when assessing the plan of care. The Frequencer V2X may offer a viable alternative to PD&C for medically fragile infants with BPD. Sponsored Research - None