![]() 14 The TBAcare device (First Medica, Cusago, Italy) is connected to the ventilator circuit close to the endotracheal tube and generates an acoustic and visual signal with the automated detection of crackles when airway secretions are present. 14 The dynamic lung image generated with VRI provides a continuous visualization of the characteristics of breath sounds along the complete breathing cycle. A commercial acoustic lung-imaging technology known as vibration response imaging (VRI) represents the unique distribution of breath sounds using a grayscale image. 9– 13 This methodology may be able to standardize the detection of airway secretions in the mechanically ventilated patient. 7, 8 Unfortunately, there are currently no reliable methods to predict the airway secretion wet-weight to be cleared with chest physiotherapy, making it unclear when airway suction alone is sufficient or when chest physiotherapy is indicated.Ĭomputer-based acoustic technology provides objective and reproducible measurements of breath sounds in normal and in mechanically ventilated subjects with parenchymal lung diseases. 5 Chest physiotherapy techniques can increase the weight of airway secretions cleared (on average 5 g), which can result in improvements in respiratory compliance 6 and re-expansion of a collapsed lung. 4 Chest physiotherapy in the mechanically ventilated patient can be used to assist with secretion clearance and may include techniques such as patient positioning (often head down), manual chest wall techniques (eg, chest wall percussion and vibrations), and manual/ventilator lung hyperinflation. 4 However, the clinical impact of the 0.5-mL secretion on patient outcomes is unknown. The likelihood ratio to detect airway secretions > 0.5 mL with airway suctioning increases to 14.7 when adventitious breath sounds and the sawtooth expiratory flow pattern are both present. ![]() 4 These indicators can detect the presence of airway secretions > 0.5 mL, obtained with airway suctioning, with likelihoods ratios of 2.50 and 2.75, respectively. 2 Clinical indicators of the need for airway suctioning in mechanically ventilated patients currently include the presence of adventitious breath sounds centrally located on lung auscultation 3 and a “sawtooth” pattern on the ventilator expiratory flow waveform. ![]() 1 Airway suctioning is the current standard of care for secretion clearance in the mechanically ventilated patient. Endotracheal intubation and mechanical ventilation impair secretion clearance and can lead to lung collapse, consolidation, and ventilator-associated pneumonia.
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