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Medical Science Monitor Basic Research


A Novel Ventilatory Technique in Refractory Hypoxemic Respiratory Failure Secondary to Therapeutic Thoracentesis and Paracentesis

Unusual or unexpected effect of treatment

Kimberly Blair Caldwell

USA Hospitalist Department, Mary Immaculate Hospital, Newport News, VA, USA

Am J Case Rep 2020; 21:e924862

DOI: 10.12659/AJCR.924862

Available online: 2020-07-14

Published: 2020-08-25

BACKGROUND: MetaNeb® is a respiratory therapy modality that aims to effect clearance of airway secretions through chest physiotherapy. It typically is used in critically ill patients with bronchiectasis or copious secretions. However, it also expands lungs through a continuous positive expiratory pressure and continuous high-frequency oscillation, which has the benefit of increasing lung recruitment and improving oxygenation.
CASE REPORT: A 61-year-old male who had re-expansion pulmonary edema following a paracentesis and thoracentesis for cirrhosis, which caused a large unilateral pleural effusion. He required intubation and his hypoxemia was refractory to standard maximum ventilatory measures. A trial of continuous MetaNeb® acted as a noninvasive extracorporeal membrane oxygenation method, dramatically improving oxygenation and hypoxemia, normalizing the patient’s blood gas, and thus stabilizing him.
CONCLUSIONS: MetaNeb® could potentially be used in other community hospitals that lack the capability for advanced ventilatory modes or in patients who are too unstable for transfer.

Keywords: Hypoxia, Brain, Pulmonary Edema, Ventilators, Mechanical