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. 17/2012In the patients submitted to domiciliary continuous mechanical ventilation for neuromusculardisease with a cough deficit the use of VEST is used with the purpose to reduce theincidence of respiratory infectious complications and to reduce the hospital refuges.In these patients it is functional to make follow the treatment with VEST with the use of theMI-E.The use of the MI-E it results particularly useful in the patients affected from neuromusculardisease both in case of NIV and in the subject with tracheostomy tube.As a matter of fact the use of VEST is possible during the invasive and non invasivemechanical ventilation.During the IMV we alternate brief treatments of VEST (2 minutes) to the use os MI-E (3-4cicles) followed by aspiration with suction catheter.The general treatment with VEST has a duration of about 10 minutes repeated at least 2 timesa day.During the NIV, in case of ineffective cough, we alternate VEST to MI-E with a particularattention to the secretions to avoid impediment of the big aerial streets.It is correct to consider the possibility that the use of VEST during the ventilation interfereswith the present systems of analysis of the pressure and the aerial flow of the ventilator. Thedata of these parameters could be altered.Fig 1. Alterations of the survey of the aerial flow3
Azienda Ospedaliera Nazionale“SS. Antonio e Biagio e Cesare Arrigo”Working Paper of Public Healthnr. 17/2012Fig 2. Alterations of the survey of the pressure in the aerial streetsWe use habitually the VEST with a frequency of 10-15 Htz for 10 minutes 2-3 times a day inpatients with atelectasia, bronchial ipersecretions and difficulty to the weaning from themechanical ventilation.The mobilization of the secretions in these patients reduces the incidence of infections andthe use of the respiratory muscles thanks to the reduction of the resistances of the aerial ways;it allows, in addition, the reduction of the necessary time to get the weaning from the VM.Fig. 3 Complete atelectasia of left lung4
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