Ferguson Alexandra, Wright Sarah
Children's Health Queensland Hospital and Health Service, Brisbane, Australia.
Respir Med Case Rep. 2017 Sep 6;22:232-234. doi: 10.1016/j.rmcr.2017.08.020. eCollection 2017.
The Metaneb is a new generation Intrapulmonary Percussive Ventilation device utilised by the physiotherapist to assist airway clearance by providing calibrated oscillations during inspiration up to 3.8Hz. Predominantly used in the adult chronic respiratory patient, with anecdotal evidence in intubated patients, it was also proven to be safe in a paediatric lung model lab study. This case report outlines the first use of the Metaneb with an intubated child in Australia. The 8 year old patient was retrieved to Lady Cilento Children's Hospital with 61% total body surface area flame burns. The child was difficult to ventilate, immobile, and had retained secretions. The chest x-ray (CXR) demonstrated multifocal regions of atelectasis.
To report safe and effective use of the Metaneb airway clearance in the paediatric intubated patient.
The Metaneb was applied using an open ended bagging circuit on Continuous High Frequency Oscillation mode for a period of 10 min per treatment. The circuit contained an inline nebuliser containing 5ml 0.9% normal saline. PEEP was maintained and variable volume breaths were delivered with suction performed as required. Outcome variables to be measured included sputum weight and quality, CXR, and Peak Inspiratory Pressure (PIP) values pre and post treatment. Vital signs were monitored throughout.
The patient's vital signs remained stable throughout intervention. After 4 days of treatment twice daily, there was resolution of focal changes on CXR, improvement in secretions, a reduction in PIP and the patient was extubated.
The Metaneb was used safely and effectively in this patient to assist in resolution of respiratory pathology. Metaneb provided a new option for physiotherapy treatment when positioning and handling restrictions limited usual care. This ultimately optimised PICU Length of stay and patient morbidity and mortality. Metaneb provided by Hill-Rom Australia.
Metaneb是新一代肺内叩击通气设备，物理治疗师可利用它在吸气时提供高达3.8Hz的校准振荡，以协助气道清理。它主要用于成年慢性呼吸疾病患者，在插管患者中也有一些传闻证据，并且在一项儿科肺模型实验室研究中被证明是安全的。本病例报告概述了澳大利亚首例在一名插管儿童中使用Metaneb的情况。该8岁患者因全身61%体表面积火焰烧伤被转送至西伦托夫人儿童医院。该患儿通气困难、行动不便且有分泌物潴留。胸部X光片（CXR）显示多处肺不张区域。
报告Metaneb气道清理在儿科插管患者中的安全有效使用情况。
采用开放式通气回路，以持续高频振荡模式应用Metaneb，每次治疗持续10分钟。回路中包含一个装有5毫升0.9%生理盐水的在线雾化器。维持呼气末正压（PEEP），按需进行吸引并给予可变容积呼吸。待测量的结果变量包括治疗前后的痰液重量及质量、CXR和吸气峰压（PIP）值。全程监测生命体征。
在整个干预过程中患者生命体征保持稳定。每日两次治疗4天后，CXR上的局灶性改变消失，分泌物改善，PIP降低，患者拔管。
在该患者中安全有效地使用了Metaneb以协助解决呼吸病理问题。当体位摆放和操作限制影响常规护理时，Metaneb为物理治疗提供了新的选择。这最终优化了儿科重症监护病房（PICU）的住院时长以及患者的发病率和死亡率。Metaneb由澳大利亚Hill-Rom公司提供。
