SUCCESSFUL USE OF HIGH FREQUENCY CHEST WALL OSCILLATION IN PEDIARTIC POST OPERATIVE SPINAL FUSION

Background: 4 patients with idiopathic scoliosis, treated in the postoperative period with High Frequency Chest Wall Oscillation (HFCWO) were reviewed retrospectively. All four patients were in the Pediatric ICU and had undergone posterior spinal fusion. Radiographic review of therapeutic airway clearance was undertaken.

Objective: To review the hospital course of 4 adolescents with significant airway clearance issues and/or atelectasis and pleural effusions.

Method: We choose HFCWO with the VEST System in patients with an inadequate cough due to post operative pain, an artificial airway for ventilatory support or neuromuscular disease. All patients were treated for 20-30 minutes with a Pressure + 3 and Frequency of 15 HZ. Treatments were repeated every 2-4 hours.

Outcome: Patient one was treated on day 5 post operatively for persistent Left Lower Lobe (LLL) infiltrate vs. atelectasis after failing standard positioning and postural drainage techniques. Started on the VEST every 4 hours and then increased to every 2 hours for one day. Repeat x-ray the following day showed improved aeration LLL. Patient two was treated on the 3^rd day post operatively for Right Lower Lobe (RLL) infiltrate vs. atelectasis with small right pleural effusion. VEST treatments were initiated every 4 hours. After 6 treatments, repeat x-ray showed increase aeration of the RLL. Patient three initially showed normal aeration post operatively while ventilated. After 14 hours x-ray showed opacification of left hemithorax with bronchial ?cut off? sign, suggesting collapse due to mucous plugging. After increasing PEEP, to 8cm, there was no improvement. Aerosolized D-Nase was administered in conjunction with a VEST treatment, and this was followed by four VEST treatments given every 2 hours. Thereafter repeat x-ray showed dramatic interval improvement in left lung aeration with persistent left pleural effusion and minimal residual LLL atelectasis. 15 hours later repeat x-ray showed almost complete resolution done.of atelectasis with increased Right Upper Lobe (RUL) atelecatasis. Patient was extubated and repositioned with head to 45 degree and contunued VEST treatments. Follow up x-ray showed improved aeration of RUL. There was still a small residual left plueral effusion with minimal atelecatsis in the LLL. Patient four was started immediately post operatively on VEST every 4 hours, while on ventilatory support,. The frequency of treatments remained every 4 hours for the first 4 days post operative. Radiographic review during this patient?s stay in the Pediatric Intensive Care never showed infiltrates or atelectasis.

Conclusion: Although only four patient?s were initially studied we are confident that HFCWO with the VEST is a clinically safe and effective airway clearance technique in ventilated or post extubated patients that have undergone spinal fusion, and suggest that further studies should be