Background: Neuromuscular diseases involving respiratory muscles often requires tracheostomy for their airway management this entails ventilation and lung expansion techniques. Physiotherapy plays a vital role in managing these patients for weaning from ventilators, improving lung expansion and airway clearance. In our Indian Critical Care Unit setup there is a lack of evidence supporting the use of Mapleson-C circuit in neuromuscular diseased patients with tracheostomy. The study was to determine the efficacy of Mapleson-C circuit in airway clearance and lung expansion in neuromuscular disease patient.
Case presentation: A 63-year-old male patient with the diagnosis of Gullian Barrie syndrome (GBS) required mechanical ventilation support with tracheostomy and had undergone intercostal drainage for pyothorax on the left side. After weaning from mechanical ventilator support the patient required Airway Clearance and Lung expansion Techniques. Mapleson-C circuit applied was for 3 days totaling 18 sessions (for day time 4 sessions, 15 minutes/session, 12 breaths/minute, during night time only 2 sessions). Chest radiograph (Atelectasis Score) and amount of sputum cleared were used as primary outcome measures.
Conclusion: Chest radiograph score showed significant improvement from score 4 to 1, and more amount of sputum removed. In the secondary outcome measures, Improvement in saturation of oxygen (86% to 98%), arterial blood gas analysis (PaO₂ increased from 70 mm Hg to 94 mm Hg and PaCO₂ decreased from 50 mm Hg to 42 mm Hg), reduced use of accessory muscle of respiration and decrease in respiratory rate of about 10 breaths/minute. Finally, the Mapleson-C circuit is a very effective technique for lung expansion and airway clearance.
Adv. Pall. Med. 2010; 9, 2: 49–52