Respiratory Therapy Chile

In this opportunity, I want to share with you a work that I developed together with my colleagues of the hospital (Roberto del Río). The work consisted of measuring the immediate effects of the chest physiotherapy (CPT) in pediatric patients who presented acute lung injury due viral infection and who needed High Frequency Oscillatory Ventilation (HFOV).

8 patients between June and August, 2006 were recruited and 42 interventions were performed with his respective measurements. We evaluated the haemodynamic and respiratory state previously and after the CPT. The criteria of success included supporting the hemodynamic and the respiratory stability. For the measured parameters we applied the t of Student for pairing samples.

The age mode was 1 month (1 – 15 months) and the patients were in VAFO in average 12,2 days (median of 5 days) after having been, in average, 2,62 days in mechanical conventional ventilation.

To these little patients we performed maneuvers of acceleration of expiratory flow, principally as rib cage compressions single sided or bilaterally , with preoxygenation to 100 %, and endotracheal suctioning with closed system.

54,76 % (23/42) of the interventions was realized on the patient in prone position, which was determined by the physician in charge.

Of the whole of interventions, 52,38 % (22/42) was performed with the patient connected to the oscillator, 26,19 % (11/42) with a self-inflated bag connected to a PEEP-valve  and 21,40 % (9/42) with an Anesthesia bag Jackson-type. Both for the self-inflated bag  and for the anesthesia bag, a PEEP of 10 cmH2O was fixed .

The CPT interventions lasted an average of 13,72 minutes, from the moment to initiate the maneuvers.

None of the hemodynamics parameters had significant changes between the measurements, except the heart rate that, in average, increased in 5 points on the basal (p=0,03), but this increase was transitory, associated to the intervention and without later consequences.

The ventilatory parameters did not also register substantial changes, not being necessary, for any case, recruiting maneuvers like increase of the Airway Pressure nor FiO2.

The pulse oximetry, showed a tendency to the increase between the initial measurement and the later one to the procedure, without reaching a significant difference (p=0,06).

There was no died patient in the studied group. One patient presented Pneumothorax before initiating the HFOV. None of other patients presented air leakage.

For our studied group, the performing of CPT, in patients connected to HFOV, with acute lung injury of viral etiology and controlled hemodynamic state, is sure and it did not mean ventilatory nor circulatory alterations.

Recently, the hospital acquired three Respironics Vision ventilators with the optional ones (O2 and PAV).

Like almost the whole technology, it is subused and we do not take advantage of all the services that are delivered by the equipment.

The thing is that I dared to use assisted proportional ventilation (PAV) in a little girl of 3 years old. All the experience in the use of PAV is in adults.

She was a patient who was presenting a principally obstructive alteration, from what the programming of the ventilation was done in accordance with this premise.

The good thing of all this is that there was complicity with the resident physician who was on shift. She allowed me to prove a ventilatory programing absolutely new for us.

The patient was spectacularly well. It came with score from respiratory difficulty of 11 points of 12 (Wood and Downes score). Up to 30 minutes it had descended to 8 points and 6 hours later the score was in 6 points.

I set the ventilator “proving” parameters until the patient felt calm with the equipment.

I will keep on trying with this ventilator mode that has the ability of supporting according to the effort of the patient. That is to say, to major ventilatory effort, major delivery of flow of assistance and of volume of assistance. This is the difference with not invasive normal ventilation, in which there does not matter which is the ventilatory effort of the patient, the pressure support remains unaltered.