Slide 1

Normal HFCWO HFCWC Intrapulmonary Percussive

Slide 2

Case Report 7/14-8/3/2011 21 year old female admitted with acute respiratory failure requiring mechanical ventilation Received lung transplant prior year Developed failure to thrive and acute on chronic hypercarbic respiratory failure Past medical history of bronchopulmonary dysplasia, asthma, DVT, and immunosuppresant therapy

Slide 3

Case Report 7/14-8/3/2011 Prior to intubation FVC was reduced from baseline 600-700 cc to 300cc. Baseline PaCO2 70 mm Hg and had risen to 124 despite optimal mechanical ventilation.

Slide 4

Case Report 7/14-8/3/2011 Pressure/Volume curve obtained to assess potential for lung recruitability. High recruitability Our Patient (Increased PV Hysteresis) Minimal PV Hysteresis)

Slide 5

Case Report 7/14-8/3/2011 Tracheal Gas Insufflation (TGI) initiated to decrease PaCO2 which had risen to >129. 7Lpm Pre TGI Post TGI pH 7.18 7.25 PaCO2 129 97

Slide 6

Case Report 7/14-8/3/2011 Heliox initiated to further facilitate improving PaCO2 and minimize AutoPEEP, however several trials failed due to hypoxia. Chest X-ray had obviously worsened.

Slide 7

Case Report 7/14-8/3/2011 During 2 nd day of MetaNeb in-services and we suggested the use of MetaNeb to pulmonary intensivist for secretion clearance. Although initially reluctant, MD agreed. CHFO mode was used to deliver 10-20 cc of Normal Saline Q4.

Slide 8

CXR Improvement 7/19/2011 7/20/2011

Slide 9

Physician Notes 24 later

Slide 10

Case Report 7/14-8/3/2011 Patient survived hospital stay and was extubated several days later. Recently received her second lung transplant (for a total of 3 sets of lungs she has possessed). Patient is doing fine Even more important, the therapy left a lasting impression with the physician.

Slide 11

In Summary 1. RT Protocolized BHT approaches are better than Physician directed therapies. 2. Do not underestimate the benefits of optimal humidified O2 delivery & hydration 3. Conventional CPT is subpar at best. Dont default to it because of an inability to evolve 4. Consider High Frequency devices 5. Individualize Patient Care