Physiotherapy Management for Complete Right Lung Collapse- is there role of mechanical insufflation and exsufflation? -A Case Report

Abstract

We are reporting, a case of 52 year old male, with obstructive uropathy who underwent cystolithotripsy surgery associated with chronic kidney disease presented with respiratory distress, tachypnea and hypoxia on 3rd post-operative day. He was on maintenance hemodialysis. Examination revealed absent air-entry on right side, dull percussion note on right side and positive trail sign. Chest X-ray and HRCT showed complete collapse of right lung with ipsilateral shift of trachea with mediastinum. Conventional physiotherapy postural drainage, breathing exercises, active cycle of breathing technique, forced expiratory techniques, spirometry, nebulization given for a day, no improvement seen because patient had strong cough reflex but unable to expectorate; any effort to cough caused more distress and breathing difficulty. Mechanical insufflation-exsufflation, a therapy in which the device which inflates the lungs(Insufflation pressure start at 15-20 cmH2O and increase to give an inspiration to total lung capacity, last for 2 second) followed by an immediate and abrupt change to negative pressure (exsufflation pressure same as the insufflation, then increase up to 10–20cmH2O, held for 3-6 second), which produces rapid exhalation, simulates cough and thus moves secretions cephaladly. Thus device helps patient cough out effectively. Lung collapse resolved within 1 day, regular physiotherapy was given to prevent recurrent lung collapse until discharge, X-ray and auscultation findings and oxygen saturation improved. It concludes, successful utilization of chest physiotherapy and mechanical insufflators-exsufflators aids in the resolution of lung collapse in an urgent situation. KEYWORDS: Mechanical insufflator-exsufflator, Atelectasis, chronic kidney disease, cystolithotripsy