Justification for Chest Physiotherapy during Ultra‐Protective Lung Ventilation and Extra‐Corporeal Membrane Oxygenation: A Case Study

• Published in: Physiotherapy research international : the journal for researchers and clinicians in physical therapy Vol. 19; no. 2; pp. 126 - 128
• Main Authors: Cork, G., Barrett, N., Ntoumenopoulos, G.
• Format: Journal Article
• Language: English
• Published: United States 01.06.2014
• Subjects: Adult; Bronchoscopy; Drainage, Postural; Extracorporeal Membrane Oxygenation; extra‐corporeal membrane oxygenation; Humans; influenza; Influenza A Virus, H1N1 Subtype; Influenza, Human - complications; Male; mechanical ventilation; physiotherapy; Respiration, Artificial - methods; Respiratory Dead Space; Respiratory Insufficiency - etiology; Respiratory Insufficiency - therapy; influenza; extra-corporeal membrane oxygenation; mechanical ventilation; physiotherapy
• ISSN: 1358-2267; 1471-2865; 1471-2865
• DOI: 10.1002/pri.1563

Background and purposeThis case report describes the chest physiotherapy (CPT) intervention provided to a 32‐year old man with severe respiratory failure undergoing extra‐corporeal membrane oxygenation (ECMO) support and ultra‐protective ventilatory strategy. Low tidal volume ventilation when used in patients with extremely low dynamic respiratory compliance may predispose the patient to secretion retention, and the role of CPT in this setting is unclear. MethodThe method used is a single subject case report. Written consent obtained from patient's representative. SummarySecretion clearance in this patient was initially limited to suctioning; however, after developing major airway occlusion secondary to impacted secretions, he received intensive CPT consisting of positioning, ventilator hyperinflation, expiratory chest wall shaking and suctioning. After 13 days of two to three times daily CPT, the patient weaned from ECMO support. DiscussionRegular CPT may have facilitated secretion clearance and lung recovery in this patient. Future research should investigate the optimal CPT techniques for patients with sub‐dead space tidal ventilation and extremely low dynamic respiratory compliance during ECMO with ultra‐protective ventilatory strategy (UPVS). Copyright © 2013 John Wiley & Sons, Ltd.