Resolution of left lower lobe collapse postesophagectomy using the Medivent RTX respirator, a novel noninvasive respiratory support system

Removal of lung lavage fluid during whole-lung lavage using biphasic cuirass ventilation chest percussion in a patient with autoimmune pulmonary alveolar proteinosis

Autoimmune pulmonary alveolar proteinosis (PAP) is a rare lung disease. Although recombinant human granulocyte macrophage colony-stimulating factor (GM-CSF) therapy has emerged as a new therapeutic modality, whole-lung lavage (WLL) with manual chest percussion has been a standard therapy in advanced cases. The application of biphasic cuirass ventilation (BCV) instead of chest percussion has rarely been reported. We describe the case of a patient with advanced PAP who recovered well in both lungs, without complication, after we performed WLL with BCV under anesthetic mechanical ventilation. Both radiographical chest findings and clinical symptoms were improved, and oxygen therapy was finally withdrawn. This case illustrates that BCV can enhance the effective removal of lavage fluid and is an alternative to manual percussion.

Marked improvement of extensive atelectasis by unilateral application of the RTX respirator in elderly patients

The RTX respirator is a biphasic external cuirass-style ventilator that supports both inspiration and expiration at various cycle rates and pressures, as well as allowing application of the vibration and cough modes. With this respirator, the duration and pressure can be altered in both the inspiratory and expiratory phases, and it can promote the removal of secretions by switching between the vibration mode (which involves external high-frequency oscillation: EHFO) and the cough mode. We used this respirator to remove secretions in two elderly patients with extensive atelectasis. They were nursed in the lateral decubitus position with the cuirass attached to one side of the chest only. The vibration mode removed secretion to reduce the viscosity of secretions and loosen impacted bronchial secretions. The cough mode interrupts the vibration mode and forces secretions towards the pharynx. The lateral decubitus position was useful for postural drainage. The extensive atelectasis of both patients was improved by this procedure. The RTX respirator may be a useful tool for the management of elderly patients with sputum retention.