Treatment for Collapsed Lung in Critically III Patients: MATERIALS AND METHODS
Twelve patients were admitted to the medical or surgical ICU for the different critical conditions (Table 1). The duration of lung collapse ranged from 24 to 120 hours. All had received intensive respiratory care since admission to prevent atelectasis. When the lung collapsed, another 24 hours of respiratory therapy was performed before the fiberoptic bronchoscope procedure.
A fiberoptic bronchoscope was used. A three-way adaptor was connected to the suction channel of the bronchoscope. One port was used to introduce room air by Ambu bag, the other port was connected to a pressure gauge to monitor the peripheral airway pressure during air insufflation (Fig 1).
FIGURE 1. The whole apparatus included a fiberoptic bronchoscope, an ambu bag and a pressure gauge were connected to a three-way adaptor (arrow).
The bronchoscopy was performed transnasally in the four patients who were not intubated. In the eight intubated patients, the bronchoscopy was performed through a swivel adaptor connected to the mechanical ventilator as described in previous studies.”Repetitive sputum suctioning and bronchial washing with normal saline solution was done until all the visualized airways were clear. We then wedged the bronchoscope into each segment or subseg- ment of the collapsed lobe and rapidly insufflated room air into the selected airways by Ambu bag for one to two minutes, keeping the peripheral airway pressure around 30 cmH20, or 10 cmH20 higher than the previous airway pressure. The duration of the 14 procedures ranged from 20 to 30 minutes. The eight intubated patients received 100 percent oxygen by mechanical ventilation during the whole procedure. The four nonintubated patients were given as high as possible Flo, by mask. The vital signs were monitored by ECG monitor and arterial line or frequent measurement by sphygomanometer.
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Arterial blood gas values were checked just before the bronchoscope procedure, then 30 minutes, 12 and 24 hours after. A portable chest x-ray examination followed soon after the procedure.