High-frequency percussive ventilation for airway clearance in cystic fibrosis: a brief report.
Exacerbations of cystic fibrosis (CF) lung disease are characterized by increased inspissation of abnormally viscid pulmonary secretions with resultant plugging of small airways, worsened ventilation/perfusion mismatch, and increased physiological deadspace. In this circumstance, hypoxic respiratory failure necessitating mechanical ventilation can be life-threatening. We present such a case of CF lung disease poorly responsive to conventional mechanical ventilatory strategies, in which high-frequency percussive ventilation (HFPV) using volumetric diffusive respiration mobilized copious amounts of inspissated pulmonary secretions and improved refractory hypoxia. Subsequent transient hypercarbia necessitated titrating ventilator parameters to return the PaCO(2) to baseline; the voluminous clearance of secretions and improvement in oxygenation were sustained. HFPV appears unique in its ability to function as a methodological continuum from noninvasive percussion to invasive percussive ventilation for airway clearance, a fundamental tenet of the CF treatment paradigm.
Dmello
Dayton
D
Division of Pulmonary, Critical Care & Sleep Medicine, Saint Louis University School of Medicine, 1402 South Grand Blvd., 7 Desloge Towers, St. Louis, MO 63104, USA. ddmello@slu.edu
Nayak
Ravi P
RP
Matuschak
George M
GM
D000142:Acidosis, Respiratory / Q000097:blood / Q000209:etiology; D000328:Adult; D002245:Carbon Dioxide / Q000097:blood; D003550:Cystic Fibrosis / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000628:therapy*; D006612:High-Frequency Ventilation / Q000009:adverse effects; D006801:Humans; D008168:Lung / Q000000981:diagnostic imaging / Q000378:metabolism / Q000503:physiopathology*; D008297:Male; D011859:Radiography; D013183:Sputum / Q000378:metabolism; D016896:Treatment Outcome
D002245:Carbon Dioxide