HIGH-FREQUENCY PERCUSSIVE VENTILATION IN PATIENTS WITH CYSTIC FIBROSIS WITH ACUTE RESPIRATORY FAILURE: A CASE SERIES

Abstract

SESSION TITLE: Critical Care Posters SESSION TYPE: Original Investigation Posters PRESENTED ON: October 18-21, 2020 PURPOSE: To describe our experience with high-frequency percussive ventilation (HFPV) in adults with cystic fibrosis (CF) and acute respiratory failure that required invasive mechanical ventilation (IMV). Acute respiratory failure in CF carries a significant risk of morbidity and mortality. The optimal mode of mechanical ventilation (MV) in CF is unknown. HFPV has not been studied in CF patients, however there is well-known evidence about the benefits of chest physiotherapy especially intermittent percussive pressure. This suggests that the continuous percussions provided by HFPV could provide ongoing airway clearance and potentially facilitate liberation from mechanical ventilation. METHODS: This is a case series report of 10 CF patients at a tertiary care center intensive care unit who presented with acute respiratory failure requiring endotracheal intubation and were managed with HFPV. Electronic medical records were queried for respiratory failure and the use of HFPV. A total of 12 patient encounters met the criteria. One patient was excluded due to the presence of lung transplant and one patient had two separate encounters. RESULTS: There were 11 patient encounters (4 females) with CF and acute respiratory failure treated with HFPV, 6 (55%) of these survived to discharge and clinic follow-up. The median age was 30 (20–40) years. The median hospital length of stay (LOS) was 28 (15–37) days while the ICU median LOS was 9 (4–24) days. The median time spent on total MV was 4 (3–12) days and on HFPV 4 (2–11) days. The average baseline FEV1 prior to admission was 1.2 L, 31.4% of predicted. The 6 patients, who survived hospital discharge had a median age of 22 (22–34) years. Their hospital median LOS was 27.5 (14.25–37.5) days and median ICU LOS was 7 (3.75–19.25) days. They spent a median of 4 (3.75–11.25) days on total MV. Of those, a median of 2.5 (2–7.75) days were spent on HFPV. The average prior to admission baseline FEV1 was 1.3 L (35.3% of predicted) with an average follow-up FEV1 of 1.25 L (34.2% of predicted). All the patients in this cohort had documented improved airway clearance after implementing HFPV without documented complications. CONCLUSIONS: High-frequency percussive ventilation use in adult cystic fibrosis has not been reported in the literature. The hospital mortality rate of 45% is consistent with a recent nationwide cross-sectional study by Siuba, et al. In that study, 50% of the patients required IMV > 4 days. Our patients spent a median of 4 days on IMV with 64% spending ≤ 4 days (7 patients). The survivors' FEV1 improved close to baseline upon follow-up CLINICAL IMPLICATIONS: HFPV was well tolerated in our cohort with reported improvement in airway clearance without significant complications. whether HFPV leads to improved outcomes is yet to be decided. Further larger studies are needed before it can be universally recommended DISCLOSURES: No relevant relationships by Michael Crosser, source=Web Response No relevant relationships by Mohamad badr Jandali, source=Web Response No relevant relationships by Joel Mermis, source=Web Response