The Science Journal of the American Association for Respiratory Care

2012 OPEN FORUM Abstracts


Sabrina Cho, Maria Madden, Jillian Burkowsky, Peter Saunders, Christopher Kircher, Neal Reynolds MD; Respiratory Care, University of Maryland Medical Center/R Adams Cowley Shock Trauma Center, Baltimore, MD

Introduction: IPV has been used as a method to deliver bronchodilators, enhance secretion clearance and to decrease atelectasis. Patients with traumatic brain injury (TBI) often require pulmonary toilet to mobilize secretions and chest physical therapy (CPT) is preferred method to do so. However, often TBI patients can’t tolerate laying flat due to increased intracranial pressures (ICPs) and pulmonary toilet becomes difficult to execute. We hypothesized that using the IPV could be a more effective method of secretion clearance without increasing ICPs. Case Summary: A 63 year old male was involved in a motor vehicle crash (MVC) suffering multiple right rib fractures and a brain hemorrhage in left basal ganglia extending into frontal and temporal lobes. The patient underwent a craniotomy for control of ICP and an intraventricular catheter (IVC) was placed. The patient’s ICPs increased when supine and he could not tolerate CPT as a method to mobilize pulmonary secretions. The CXR showed increasing bilateral atelectasis. An alternative means for secretion clearance was needed and IPV was initiated. IPV treatments were performed thru the ventilator and included albuterol and normal saline. During treatments the IVC was clamped. The IPV was performed Q4 and copious secretions were successfully removed without increased ICP. Within 3 days there were improvements in both CXR and ABG and ventilator support was weaned. Results: During the 3 days of IPV treatments the patient experienced marked improvement in CXR. Mechanical ventilation was successfully weaned to spontaneous pressure mode. During this period, respiratory therapists consistently charted notable increases in secretion volume removed during and after IPV treatments. Radiographic and Physiological improvements, as shown below, were directly associated to the secretions cleared with IPV treatments. Conclusion: The IPV alleviated ICP safety concerns raised by conventional CPT. Further research is needed to see the effect of IPV with TBI. Sponsored Research - None