Mechanically Ventilated Patients

Mechanical ventilation (MV) requires bypassing the upper airway, thus introducing dry air breathing inadequately compensated by the addition of humidifiers and filters. Decreased humidification injures the mucociliary transport system and causes moisture-related changes in mucus viscosity and elasticity. Concomitant ineffective cough may facilitate retrograde movement of secretions to the lung periphery or aspiration from one lung to the other, leading to ventilator-associated pneumonia (VAP). Prolonged dependence on MV diminishes likelihood of successful weaning.

  1. Gomez A, Acker R, Buehler C, Newman V. Successful use of high frequency chest wall oscillation in pediatric post operative spinal fusion. Presentation at the 48th International Respiratory Congress of the American Association for Respiratory Care, AARC 2002 Abstract; OF-O2-156.
    A retrospective hospital course chart review is reported for four adolescent spinal fusion patients (idiopathic scoliosis) in a pediatric intensive care unit (PICU) who received high frequency chest wall oscillation (HFCWO) 3-5 days post- operatively after failing other airway clearance interventions. Indications were atelectasis with or without pleural effusion and with or without evidence of mucus plugging. All patients had either inadequate cough secondary to post operative pain, an artificial airway for ventilatory support and/or neuromuscular disease. HFCWO was administered for 20-30 minutes every 2-4 hours. Radiographs after 4 days of HFCWO for all patients showed either complete resolution or minimal residual atelectasis.
  2. Ndukwu IM, Shapiro S, Nam AJ, Schumm PL. Comparison of high-frequency chest wall oscillation (HFCWO) and manual chest physiotherapy (mCPT) in long-term acute care hospital (LTAC) ventilator-dependent patients. Chest 1999; 116 (4) Suppl: 311S.
    This randomized, controlled study of 54 long-term acute care patients who had been ventilator-dependent for a median of 84 days compared chest physiotherapy (CPT) and high frequency chest wall oscillation (HFCWO) as modalities for secretion management. Subjects were randomized to receive either CPT or HFCWO 4 times daily for 15 minutes for 40 days. After 21 days, the HFCWO group discharged larger volumes of sputum and, after 40 days, 38% were weaned from ventilator dependence compared with 15% in the CPT group. No adverse events occurred. Results suggest that HFCWO is safe, effective and may promote successful ventilator weaning.
  3. Whitman J, Van Beusekom R, Olson S, Worm M, Indihar F. Preliminary evaluation of high-frequency chest compression for secretion clearance in mechanically ventilated patients. Respir Care 1993; 38:1081-1087.
    A comparison of the safety and efficacy of percussion and postural drainage (P&PD) and high frequency chest compression (HFCC) in treatment of long-term mechanically ventilated patients showed equivalent safety and efficacy; 80% of therapists believed HFCC reduced their workload.

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