The Use of a New Intra-Pulmonary Percussive Ventilation (IPPV) Device to Aid Lung Volume Recruitment (LVR) and Secretion Clearance in a Patient with C1 Spinal Cord Injury (SCI)

Rationale: A common cause of death in high SCI patients is pneumonia resulting from mucus plugging and atelectasis. The need for effective chest clearance techniques is essential to prevent mortality. Background: A 30 year old male with complete C1 SCI. Despite lung recruitment and cough augmentation strategies, the patient developed symptoms and radiological changes of bilateral collapse/consolidation. Chest x-ray (CXR) showed raised hemi-diaphragms at the 7 th rib. Previous hospital length of stay (LOS) with similar presentation had been greater than 2 weeks. Objective: To assess the effectiveness of a new IPPV device in resolving atelectasis and aid secretion clearance, thus shortening hospital LOS. Method: The Hill-Rom MetaNeb, that is capable of generating the unique flow characteristics previously seen in the IPV device (Ortiz-Pujols et al 2012) was trialled. Treatments of 10 minutes with maximal flow and high frequency oscillations (230 Hz) were performed twice per day with regular airway suction. Results: After 6 days tidal volumes had returned to normal. CXR showed improvement in collapse/consolidation – right hemi-diaphragm seen below rib 10. Conclusions: In this case report, the Metaneb seems effective at resolving atelectasis and consolidation, thus aiding secretion clearance and increasing LVR. This may have led to the reduction in LOS. Use of the Metaneb in the home setting may help maintain bronchial hygiene, preventing hospital admission however is unavailable at present. Further work on the duration and frequency of treatment is needed as current literature does not provide a consensus.