Bedside management of lung collapse in children on mechanical ventilation: saline lavage--simulated cough technique proves simple, effective.

We report a simple, four-step procedure for bedside treatment of infants on mechanical ventilation who have various degree of lung collapse unresponsive to conventional instillation of saline followed by chest percussion with endotracheal suctioning. The technique involves hyperoxygenation by bagging with 100% oxygen, deep endotracheal instillation of 0.25-0.5 mL/kg sterile saline, bagging with momentary inspiratory hold, followed by release of the hold and simultaneous forced exhalation and vibration to simulate cough, and endotracheal suctioning. This procedure was repeated three to five times on the affected side and at least once on the unaffected side; it resulted in notably improved lung expansion in 48 of 57 infants, documented by chest radiographs. The 57 infants included 48 (84%) whose chest radiographs showed airways occluded by mucus ("no air bronchograms") and 7 (16%) whose chest radiographs showed patent airways ("air bronchograms"). The technique is less successful in the latter group of patients in whom material obstructing proximal and intermediate airways has already been removed or displaced to distal airways, or a parenchymal infection has developed.