title: Justification for chest physiotherapy during ultra-protective lung ventilation and extra-corporeal membrane oxygenation: a case study.
abstract: OBJECTIVE
  This 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.
  
  
  METHODS
  The method used is a single subject case report. Written consent obtained from patient's representative.
  
  
  CONCLUSIONS
  Secretion 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.
  
  
  CONCLUSIONS
  Regular 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).
authors: Physiotherapy Department, Guy's and St Thomas' NHS Foundation Trust, London, UK; Kings Health Partners, London, UK.
authors: G
authors: G
authors: Cork
authors: N
authors: N
authors: Barrett
authors: G
authors: G
authors: Ntoumenopoulos
mesh_terms: D000328:Adult; D001999:Bronchoscopy; D015916:Drainage, Postural; D015199:Extracorporeal Membrane Oxygenation; D006801:Humans; D053118:Influenza A Virus, H1N1 Subtype; D007251:Influenza, Human / Q000150:complications*; D008297:Male; D012121:Respiration, Artificial / Q000379:methods*; D012126:Respiratory Dead Space; D012131:Respiratory Insufficiency / Q000209:etiology / Q000628:therapy*
keywords: extra-corporeal membrane oxygenation; influenza; mechanical ventilation; physiotherapy