Working Paper of Public Health Volume 2012 - Azienda Ospedaliera ...

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Azienda Ospedaliera Nazionale“SS. Antonio e Biagio e Cesare Arrigo”Working Paper of Public Healthnr. 10/2012oxyhemoglobin desaturation. For this reason is important to consider alternative techniques thatprovide tools to reduce the muscular work for the mobilization of the patient's secretions. One ofthese new techniques considered particularly effective is the VEST.5. Using of VEST in neuromuscular diseases.The VEST with the vibrations transmitted to the chest can play a key role in helping the removalof bronchial secretions and reduce the incidence of atelectasis in patients with neuromusculardisease. The high frequency oscillations transmitted from the chest wall to bronchial secretionsinduced a more easily detachment from the wall and also a change of their qualitativecharacteristics. Secretions become more fluid and more easily removable. The parameters are setby in a not-standards way to differentiate the therapy in different patient to obtain a maximumtolerated pressure for every patient. However in our experience a successful plan follow a schemewith a vibration of 7-8 Hertz and a pressure of 6-8 cm H2O for a period of about 10 minutes. Thefrequency and the pressure are increased gradually until reaching the maximum tolerated by thepatient. The sessions last about 10 minutes and are repeated 3 times a day. In some patients weused treatments with different frequency and pressure during the day to put in resonance differentbronchial and pulmonary structures. Patient who still has an effective cough can eliminatespontaneously and easier also the most profound secretions. Patient who are tracheotomised can beaspirated easily. Patient not tracheotomised with ineffective cough can use Mechanical In Ex-Sufflator after the treatment session with VEST or in a pause of the VEST treatment if the quantityof secretions mobilized becomes important. VEST and Mechanical In Ex-Sufflator have theadvantage of not requiring any cooperation from the patient and can be used both in the acutephase - even during mechanical ventilation – and in the chronic phase. Their use can also be doneto the patient’s home being particularly simple to use and really easy the training of a care giver.In our experience the use of VEST together with MIE has become a classic instrument to preventrespiratory infection and has enabled a reduction of hospitalization in neuromuscular patients.Table 1: Reference values of PCEFPCEF > 360 L / m 'Normal in adultsPCEF < 160 L / m 'Clearance bronchial secretions insufficient (adult)PCEF > 160 L / m 'Bach JR et al.Arch Phys Med Rehabil (1993)Bach JR et al.Chest (1996)Mier-A JedrzejowiczAm Rev Respir Dis (1988)6
Azienda Ospedaliera Nazionale“SS. Antonio e Biagio e Cesare Arrigo”Working Paper of Public Healthnr. 10/2012Clearance for bronchial secretions insufficient duringrespiratory infectionPCEF > 270 L / m 'Value to indicate an effective coughBach JRChest (1997)Table 2: Phases of CoughIrritation Starting stimulusInspiration Precought lung volume is reached through a depth inspirationCompression The contraction of expiratory muscles to generate high pressure with closed glottisExpulsion The opening of the glottis allows air flow at high speed to clean out these secretionsfrom airwaysTable 3: Neuro muscularI. Myopathies II. SPINAL CORD DISORDERSMuscular dystrophiesSpinal muscular atrophiesDystrophinopathies Muscular (Duchenne, Becker) Motor neuron diseasesLimb-girdlePoliomielitisEmery-DreifussSpinal cord injuriaFacioscapulohumeralTransverse myelitisCongenitalIII. NeuropathiesChildhood autosomal recessiveHereditary neuropathiesMyotonic dystrophyAny condition with diaphragm paralysisCongenital and metabolic myopathiesGuillain-Barré syndromeInflammatory myopathiesMultiple sclerosisDiseases of the myoneural junctionFriedreich ataxiaMixed connective tissue diseaseIV. OTHERS DISEASESMyopathies associated with systemic conditions Familial dysautonomia, Down syndromeReferencesCastagnino M, Vojtova J, Kaminski S, Fink R. Safety of High Frequency Chest Wall Oscillation inpatients with respiratory muscle weakness. Chest 1996; 110: S65.Chiappetta A, Beckerman R. High Frequency Chest Wall Oscillation in spinal muscular atrophy(SMA). RT J Respir Care Pract 1995; 8(4): 112-114.Gomez A, Elisan I, Hardy K. High Frequency Chest Wall Oscillation: video documentation ofeffect on a patient with duchenne's muscular dystrophy and severe scoliosis. Poster presentation at7
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