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. 17/2012Title: Secretion management in the mechanically ventilated patientAuthors: Mantellini E.°, Perrero L. *, Provenzano G. *, Petrozzino S.*,Type: Original ArticleKeywords: respiratory infections; secretion management; cough; in ex suflator machine;AbstractPurpose: the aim of this work is to highlight the importance of a correct management of thesecretions in the patient submitted to mechanical ventilation (MV).Methods: analysis of the current bibliography related to respiratory infections and secretion inpatients with mechanically ventilation. We focus on the use of in-ex suflator achine(cough machine) associated with High Frequency Chest Wall Oscillation(HFCWO).Results: we observe a reduction of pulmonary infection and a better management of bronchialsecretion in patient undergone to the use of in-ex suflator machine (cough machine)associated with High Frequency Chest Wall Oscillation (HFCWO).Conclusions: the correct approach to patients submitted to mechanical ventilation (MV)expect the use of High Frequency Chest Wall Oscillation (HFCWO) (VEST)and in-ex suflator machine (cough machine) to decrease pulmonary infectionthank to a reduction of permanence of bronchial secretions in the lungs .Corresponding authorE-mail: lperrero@ospedale.al.it;Department of Rehabilitation *Respiratory and Cardiac Rehabilitation °Hospital “SS. Antonio e Biagio e Cesare Arrigo” of Alessandria, Italy1
Azienda Ospedaliera Nazionale“SS. Antonio e Biagio e Cesare Arrigo”Working Paper of Public Healthnr. 17/2012Mechanical ventilator - a device designed to support or replace spontaneous respiration - isused in patients with acute respiratory crises and/or in long-term therapy in chronichypoventilation patients affected by respiratory or neuromuscular disease.When noninvasive ventilation is not indicated, placement of an artificial airway is mandatory:endotracheal tubes for short-term use and tracheostomy tube for long-term use.Mechanical ventilation (MV) facilitates alveolar ventilation and pulmonary gas exchange;most commonly, MV is provided in intensive care unit. The most of patients receive shorttermMV therapy until the cause of respiratory crisis resolves or death occurs. However,some patients require long-term or permanent MV.Thanks to the evolution of technology and the simplification of MV devises a significantnumber of long-term MV patients receive the treatment in residential centers or at homereducing hospital stays and costs.In healthy subjects secretion clearance is primarily accomplished through mucociliary actionand cough. However some patients, for heterogeneous causes, present an inadequatemucociliary action and cough.For instance, during invasive MV, the presence of a foreign body - represented by the tube -is an important stimulus to increase secretions production.Besides, frequently these patients are affected by COPD with a permanent increased secretionproduction and/or are motionless patients with inefficient cough.Impaired airway clearance mechanisms with infection risks associated with bypassed upperairways and immobility effect increased risk of pulmonary infections.From these clinical considerations emerges the importance of a correct management of thesecretions in the patient submitted to mechanical ventilation.We can distinguish the patients in 2 groups in view of the prevalence of obstructive bronchialillness (group A) or neuromuscolar disease (group B) considering the different characteristicsfrom our point of view.It results moreover important to differentiate the invasive ventilation from the non invasive.In patients submitted to invasive mechanical ventilation in the department of intensive care itis helpful to be able to have systems able to remove the deepest secretions, mostly if arepresent phenomena of atelectasia with stagnation of secretions that usually concern thedeepest zones of lungs.The VEST devise is effective in this occasion also in patient not collaborating submitted tocontrolled ventilation.2
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