High Frequency Chest Wall Oscillation for Atelectasis in Infants and Toddlers: A Case Series Report.

SESSION TITLE: Pediatric Medicine PostersSESSION TYPE: Original Investigation PosterPRESENTED ON: Wednesday, October 29, 2014 at 01:30 PM - 02:30 PMPURPOSE: There are no published guidelines, clinical trials or case series in the management of recalcitrant atelectasis in the infants and toddlers with high frequency chest wall oscillation (HFCWO).METHODS: A retrospective case series of the clinical experience in the management of atelectasis with HFCWO in post term infants and toddlers was conducted at Driscoll Children's Hospital including noncardiac, cardiac, non PICU and PICU patients from December 2010 to March 2014. The HFCWO device used was the SmartVest™ 17-25cm Wrap® (Electromed®, New Prague, MN, USA). No funding was provided by Electromed®; no author has financial conflict of interest. Patients had radiographic evidence of atelectasis not responding to mucolytic therapy (either nebulized 3% or 7% hypertonic saline) and conventional chest physiotherapy.RESULTS: 23 patients with 26 separate admissions with post term ages of 2 weeks to 17 months were treated. Four were in the PICU, the others were in general pediatrics. Atelectasis etiologies were infectious, structural, neurological, post-surgical, congenital defects of the airways and congenital heart disease with compression of bronchi. The greatest cause of atelectasis was infectious (23, 88%), rhinovirus being the most common (9, 35%). Other causes and comorbid conditions were: neurologic conditions (6, 23%), airway anomalies (6, 23%), and cardiovascular anomalies (3, 11%). HFCWO was well tolerated, with only 3 patient (11%) having documented adverse events consisting of posttussive emesis (2, 8%) right after initiation of HFCWO or excessive coughing (1, 4%). A combination of 8 Hertz x 10 minutes, then 10 Hertz x 10 minutes at pressure of 15 was the best tolerated setting for the infants and toddlers with 23 (88%) having these settings. Patients with viral infectious etiologies consistently had more rapid resolution of the atelectasis (mean 2 days) than those with structural &/or cardiac anomalies (mean 9 days).CONCLUSIONS: HFCWO with a size appropriate device, combined with nebulized 3% or 7% saline, for post term infants and toddlers is well tolerated and should be considered as a tool for treating recalcitrant atelectasis.CLINICAL IMPLICATIONS: In post term infants and toddlers with recalcitrant atelectasis, HFCWO, with a size appropriate device, used concurrently with nebulized 3% or 7% saline, may be effective therapy. Clinical randomized trials are warranted for comparing HFCWO vs. traditional chest percussive therapy in infants and toddlers for managing atelectasis.DISCLOSURE: The following authors have nothing to disclose: Paul Nolan, Hari Gourabathini, Chau Tran, Saloni Paudel, Elena RomeroNo Product/Research Disclosure Information.