A Comparison of Manual to Mechanical Chest Percussion for Clearance of Alveolar Material in Patients With Pulmonary Alveolar Proteinosis (Phospholipidosis)

Hammon, Willy E.; McCaffree, D. R.; Cucchiara, Andrew J.

doi:10.1378/chest.103.5.1409

Cited by 49 publications

(28 citation statements)

References 6 publications

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“…95,126,[153][154][155][156][157][158][159][160][161][162][163][164][165][166][167][168][169][170][171][172] The modifications include routine use of general anesthesia, 153,154 larger lavage volume, 154,155 lobar lavage, 162 positional clearance, 161 and chest percussion. 159,161 Additionally, successful completion of bilateral sequential 126 and simultaneous 163 wholelung lavage in the same session has been achieved. Special circumstances such as advanced pulmonary alveolar proteinosis or cor pulmonale may dictate modification of the technique, including hyperbaric oxygen, 158 inhaled nitric oxide, 167,172 and extracorporeal membrane oxygenation.…”

Section: Whole-lung Lavagementioning

confidence: 99%

“…173,175 Physical therapy (manual percussion, vibration, and chest compression) started during last the two thirds of infusion of saline and continuing till drainage can significantly increase the amount of material removed. 159,174 Combination of physical therapy and gravity drainage optimizes the effective removal process. The benefits of whole-lung lavage are related to the physical removal of proteinaceous material and the local anti-GM-CSF antibodies, which restores the migration and phagocytic functions of alveolar macrophages.…”

Section: Whole-lung Lavagementioning

confidence: 99%

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Pulmonary Alveolar Proteinosis

Khan

Agarwal

2011

Respir Care

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Section: Whole-lung Lavagementioning

confidence: 99%

Section: Whole-lung Lavagementioning

confidence: 99%

Pulmonary Alveolar Proteinosis

Khan

Agarwal

2011

Respir Care

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“…This technique has been improved over the years in order to enhance the removal of material from the alveoli [19][20][21][22][23]. Few studies have reported on the protein concentration, the kinetics of the wash-out process and the factors that can influence the biochemical composition of the fluid [15,24,25].…”

mentioning

confidence: 99%

“…PASCHEN et al [15] described the kinetics of the wash-out in 10 patients with a total of 45 WLLs and pointed out that monitoring of biochemical variables can help to improve the efficacy of the wash-out. HAMMON et al [20] compared manual and mechanical percussion in regard to clearance of alveolar material in one PAP patient and concluded that manual percussion is superior to mechanical. BINGISSER et al [22] showed, in a case study, that manual ventilation between instillation and aspiration during WLL resulted in a persistent functional improvement, but recommended its application only in severely impaired patients, especially when previously performed WLL was ineffective.…”

mentioning

confidence: 99%

Wash-out kinetics and efficacy of a modified lavage technique for alveolar proteinosis

Bonella

Bauer

Griese³

et al. 2012

Eur Respir J

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Whole lung lavage (WLL) is the standard treatment for pulmonary alveolar proteinosis (PAP). This study aimed to provide data about the kinetics of the protein wash-out, to identify factors influencing the protein concentration in the recovered fluid and to assess the efficacy of a modified lavage technique.Samples of 180 WLLs from 42 adult PAP patients were collected. 110 WLLs were performed according to the classical technique. In 70 WLLs, repeated manual ventilation was applied during the procedure. Spectrophotometry was used to measure the protein concentration in the recovered fluid.The initial protein concentration in the recovered fluid was 460 mg?dL -1 , the final concentration was 26 mg?dL -1 and the total amount of removed proteins during a lavage was 17.5 g. A history of dust exposure was associated with a higher residual protein concentration in the recovered fluid (p50.000013). The amount of removed proteins correlated inversely with the diffusing capacity of the lung for carbon monoxide (p50.001) and oxygen tension (p50.004). The modified technique removed a greater amount of proteins than the classical technique and prolonged the time to relapse (p50.011). Exposure to dust seems to influence the kinetics of the protein wash-out. Applying manual ventilation during the procedure can enhance the efficacy of WLL.

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“…Chest percussion can be performed manually or mechanically. 10 With manual chest percussion, the practitioner cups his or her hands and repeatedly claps the patient's lateral and posterior thoracic region. Alternatively, many beds in the intensive care unit have programmable rotation and percussion modes capable of providing mechanical chest compression (forceful bursts of air against the inferior surface of the mattress).…”

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confidence: 99%

Effect of Mechanical Chest Percussion on Intracranial Pressure: A Pilot Study

Olson

Thoyre

Bennett

et al. 2009

American Journal of Critical Care

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Background Treatment of brain injury is often focused on minimizing intracranial pressure, which, when elevated, can lead to secondary brain injury. Chest percussion is a common practice used to treat and prevent pneumonia. Conflicting and limited anecdotal evidence indicates that physical stimulation increases intracranial pressure and should be avoided in patients at risk of intracranial hypertension.Objectives To explore the safety of performing chest percussion for patients at high risk for intracranial hypertension.Methods A total of 28 patients with at least 1 documented episode of intracranial hypertension who were having intracranial pressure monitored were studied in a prospective randomized control trial. Patients were randomly assigned to either the control group (no chest percussion) or the intervention group (10 minutes of chest percussion at noon). Intracranial pressure was recorded once a minute before, during, and after the intervention.Results Mean intracranial pressures for the control group before, during, and after the study period (14.4, 15.0, and 15.9 mm Hg, respectively) did not differ significantly from pressures in the intervention group (13.6, 13.7, and 14.2 mm Hg, respectively).Conclusions Mechanical chest percussion may be a safe intervention for nurses to use on neurologically injured patients who are at risk for intracranial hypertension.

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A Comparison of Manual to Mechanical Chest Percussion for Clearance of Alveolar Material in Patients With Pulmonary Alveolar Proteinosis (Phospholipidosis)

Cited by 49 publications

References 6 publications

Pulmonary Alveolar Proteinosis

Pulmonary Alveolar Proteinosis

Wash-out kinetics and efficacy of a modified lavage technique for alveolar proteinosis

Effect of Mechanical Chest Percussion on Intracranial Pressure: A Pilot Study

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