The MetaNeb® System
Contents
1. Impairment of respiratory muscle function Alterations in respiratory drive Decreased lung volumes e Surgical sitet Thoracic resections Coronary bypass grafting Upper abdominal surgeries Trauma related surgeries Head and neck procedures Some orthopedic procedures e Post surgical pain and splinting 1Yoder MA et al Perioperative Pulmonary Management August 15 2011 available at http emedicine medscape com article 284983 overviewHaw2aab6b4 25metana GW Postoperative pulmonary complications An update on risk assessment and reduction Cleveland Clinic Journal Of Medicine Volume 76 Supplement 4 November 2009 Page 5 2013 Hill Rom Services PTE Ltd ALL RIGHTS RESERVED Identifying Patients at Risk Patient Related Risk Factors for Pulmonary Complications Age and general health Smoking history Immunosupression Recent respiratory infection Productive cough wheezing within 5 days of surgery Immobility or difficult to move Obesity Weight loss Trauma Fractured ribs flail chest Head injury High level SCI Jin F Chung F Minimizing perioperative adverse events in the elderly Br J Anaesth 2001 87 4 608 624 doi 10 1093 bja 87 4 6082 Yoder MA et al Perioperative Pulmonary Management August 15 2011 available at http emedicine medscape com article 284983 overviewHaw2aab6b4 3Smetana GW Postoperative pulmonary complications An update on risk assessment and reduction Clevela2. Make The Difference 17
3. retrospective group was 1 457 0 752 Difference 0 65 95 Cl 0 075 1 225 P 0 029 e The MetaNeb System treatment had a statistically significant effect on reducing the mean length of stay OE ratio Page 46 2013 Hill Rom Services PTE Ltd ALL RIGHTS RESERVED The MetaNeb System ICU to Extended Care A nN hie Continuous pulses of positive pressure Ventilation oscillating airways to mobilizes secretion Post extubation e Help prevent respiratory complications ae management in ICU related to atelectasis amp retained secretions e Prevent or reverse atelectasis and aids in Floor Therapy the mobilization of retained secretions For Extended and Long k Enhance secretion removal and help prevent or resolve patchy atelectasis Term Care To Improve Outcomes 1The MetaNeb System User Manual 174432 REV 1 page 4 amp 6 Page 47 2013 Hill Rom Services PTE Ltd ALL RIGHTS RESERVED The MetaNeb System Summary e Three therapies in one device Lung expansion CPEP Airway clearance CHFO Aerosol delivery e Ability to provide supplemental oxygen e Provides MetaTherapy Treatment Multiple treatments delivered simultaneously Alternating lung expansion amp secretion clearance therapies Maintaining PEP amp delivering aerosol throughout treatment Page 48 2013 Hill Rom Services PTE Ltd ALL RIGHTS RESERVED 16 1 30 2014 THANK YOU You Are In The Best Position To
4. 1 30 2014 The MetaNeb System For the Treatment amp Prevention of Atelectasis and Retained Secretions patients and their caregivers Disclosures Anne Snyder RRT Clinical Education Specialist Respiratory Health Division Hill Rom Makers of The MetaNeb System The Vest Airway Clearance System The MetaNeb System Presentation Objectives Identify conditions and patient populations at risk for pulmonary complications Discuss challenges to providing airway clearance and lung expansion therapy Understand the mechanisms of action of The MetaNeb System Gain insight into which patients in the hospital may benefit from MetaTherapy Treatments Review sample literature 1 30 2014 Factors that Affect Airway Clearance Impaired mucociliary clearance Decreased ventilation lung volumes e Artificial airways mechanical e Impaired gas exchange ventilation e Alveolar impairment e Thick and or hypersecretions e Absence of periodic deep e Immobility breaths sighs e Abnormal mucous flow e Inadequate airflows Poor ineffective or absent cough Decreased respiratory drive e Pain e Sedation e Decreased muscle function e Medications e Diaphragm impairment e Neuro injuries Muscular dysfunction Page 4 2013 Hill Rom Services PTE Ltd ALL RIGHTS RESERVED Identifying Patients at Risk Procedure Related Risk Factors for Pulmonary Complications e Duration of surgery e Type of anesthesia sedation
5. 3 Hill Rom Services PTE Ltd ALL RIGHTS RESERVED 1 30 2014 The MetaNeb System Circuit with a Face Mask The MetaNeb System User Manual 174432 REV 1 page 12 14 Page 25 2013 Hill Rom Services PTE Ltd ALL RIGHTS RESERVED The MetaNeb System Circuit Single Patient Use Circuit for multiple treatment sessions Multiple patient interfaces Mouthpiece Face Mask Tracheostomy The MetaNeb System User Manual 174432 REV 1 page 12 14 Page 26 2013 Hill Rom Services PTE Ltd ALL RIGHTS RESERVED The MetaNeb System Circuit with a Tracheostomy Tracheostomy Flex Tube Adapter not included The MetaNeb System User Manual 174432 REV 1 page 12 14 Page 27 2013 Hill Rom Services PTE Ltd ALL RIGHTS RESERVED The MetaNeb System Circuit Single Patient Use Circuit for multiple treatment sessions Multiple patient interfaces Mouthpiece Face Mask Tracheostomy In line TPPePeRePRE AEE i thi ir il The MetaNeb System User Manual 174432 REV 1 page 12 14 Page 28 2013 Hill Rom Services PTE Ltd ALL RIGHTS RESERVED MetaTherapy Treatment Protocol Preparing the Controller 1 Follow institutional guidelines for infection control Fill nebulizer with prescribed medications if applicable 2 3 Set the mode selector switch to CPEP 4 Set selector ring to 1 dot position Offers 3 Levels of Positive Expiratory Pressure PEP 1 do
6. and with a soft cotton cleaning pad that is moistened with the cleaner Do not use excessive liquid or harsh cleaners Do not immerse the controller in water or let liquids enter the controller The MetaNeb System User Manual 174432 REV 1 page 21 22 Page 38 2013 Hill Rom Services PTE Ltd ALL RIGHTS RESERVED The MetaNeb System Assessment of Outcome e Frequency Common strategy ranges from two 2 to four 4 times daily In line use with a ventilator ranges from four 4 to eight 8 times daily Frequency determined by patient s response to therapy e Therapy will be discontinued per facility protocol or when one of these occur Secretion clearance is lt 5 cc per treatment for a 24 hour period The post therapy chest exam demonstrates absence of retained secretions and atelectasis Breath sounds have become clear or have improved Follow instructions stated in user manual The MetaNeb System User Manual 174432 REV 1 page 13 18 Page 32 Enhancing outcomes for 2013 Hill Rom Services PTE Ltd ALL RIGHTS RESERVED patients and they caregivers 13 1 30 2014 Bigerithms PROTOCOLS Literature The MetaNeb System Page 60 Enhancing outcomes for 2013 Hill Rom Services PTE Ltd ALL RIGHTS RESERVED 5 potions and tnak caregivers The MetaNeb System Literature Respiratory Care 2009 OPEN FORUM Abstracts The Use Of a Progressive Pulmonary Protocol in an Oncologic Intensive Car
7. ctasis For use in Acute Care and Long Term Care The MetaNeb System User Manual 174432 REV 1 page 1 6 Page 13 2013 Hill Rom Services PTE Ltd ALL RIGHTS RESERVED The MetaNeb System Description The MetaNeb System offers 3 therapies 1 Continuous Positive Expiratory Pressure CPEP e Lung expansion therapy for the treatment and prevention of pulmonary atelectasis 2 Continuous High Frequency Oscillation CHFO e Secretions mobilization therapy 3 Aerosol Mode e Aerosol Therapy Provides supplemental oxygen when used with compressed oxygen A combination therapy that provides aerosol therapy while alternating between CPEP Mode for lung expansion and CHFO Mode for airway clearance MetaTherapy Treatment The MetaNeb System User Manual 174432 REV 1 page 1 6 Page 14 2013 Hill Rom Services PTE Ltd ALL RIGHTS RESERVED CPEP Mode Continuous Positive Expiratory Pressure e Delivers flow during both inspiration and expiration to Provide continuous positive pressure Provide positive expiratory therapy Deliver aerosol Treat and prevent pulmonary atelectasis MetaNeb 3 0 System MetaNeb 4 0 System The MetaNeb System User Manual 174432 REV 1 page 1 6 Page 15 Enhancing outcomes for 2013 Hill Rom Services PTE Ltd ALL RIGHTS RESERVED patients and thew caregivers 1 30 2014 1 30 2014 CHFO Mode Continuous High Frequency Oscillation Maintains CHFO during inspiration and
8. e Unit Laura G Withers Clarence G Finch Kristen J Price Quan M Nguyen Respiratory Care and Critical Care The University of Texas MD Anderson Cancer Center Houston TX Overview A progressive pulmonary protocol utilizing lung expansion and airway clearance was implemented in order to minimize or prevent lung complications in their ICU patients Method All ICU patients received eZ PAP or Acapella QID either on admission or when extubated Respiratory Care Practitioner did complete patient assessment every shift including CXR and labs If any symptoms were present advanced to plan A or B every four hours Plan A IPV or The MetaNeb System Plan B The Vest System with EZ PAP When noted symptoms resolved patient graduated back to previous therapies QID then BID if still symptom free after 72 hours Results Improved Chest X rays post therapy Further studies examining protocol impact on ICU LOS are warranted Page 41 Enhancing outcomes for 2013 Hill Rom Services PTE Ltd ALL RIGHTS RESERVED Patients and thew caregivers The MetaNeb System Literature Respiratory Care 2006 Open Forum Abstracts A Case Study The Use of MetaNeb to Improve Secretion Removal and Reverse Atelectasis Bocci M Garcia JA Timons B Wolff R Hargett K Thornton C 2006 AARC Open Forum Abstract Avail at www rcjournal com abstracts 2006 id OF 06 113 Case Summary 80 year old male post op thoraco
9. ed Do this before to each use 6 Occlude the patient opening of the handset Watch the pressure gauge The average of pressure fluctuations should not be less than 15 and not more than 30 cm H20 7 Set the mode to CPEP 8 Turn the CPEP flow adjuster counterclockwise to full flow Make sure there is a peak pressure occurrence of not less than 20 and not more than 30 cm H20 9 If the device is not within the parameters specified above do not use the unit Contact Hill Rom Technical Support to examine and repair the unit The MetaNeb System User Manual 174432 REV 1 page 12 14 Page 21 2013 Hill Rom Services PTE Ltd ALL RIGHTS RESERVED 1 30 2014 1 30 2014 The MetaNeb System Circuit Single Patient Use Circuit for multiple treatment sessions Multiple patient interfaces Mouthpiece The MetaNeb System User Manual 174432 REV 1 page 12 14 Page 22 2013 Hill Rom Services PTE Ltd ALL RIGHTS RESERVED The MetaNeb System Circuit with the Mouthpiec m r E ri il d b The MetaNeb System User Manual 174432 REV 1 page 12 14 Enhancing outcomes for 2013 Hill Rom Services PTE Ltd ALL RIGHTS RESERVED patients ane thal corngivent The MetaNeb System Circuit Single Patient Use Circuit for multiple treatment sessions Multiple patient interfaces Mouthpiece Face Mask paeeeeetttt i beeay ee TT The MetaNeb System User Manual 174432 REV 1 page 12 14 Page 24 201
10. expiration Oscillates the airways with continuous pulses of positive pressure Higher 230 BPM or lower frequency 170 BPM Delivers aerosol Mobilizes secretions MetaNeb 3 0 System MetaNeb 4 0 System The MetaNeb System User Manual 174432 REV 1 page 1 6 Page 16 Enhancing outcomes for 2013 Hill Rom Services PTE Ltd ALL RIGHTS RESERVED patients and thal caregivers Aerosol Mode In this mode CPEP and CHFO are not available MetaNeb 3 0 System MetaNeb 4 0 System Page 17 The MetaNeb System User Manual 174432 REV 1 page 1 6 Enhancing outcomes for 2013 Hill Rom Services PTE Ltd ALL RIGHTS RESERVED patients and thew caregivers The MetaNeb System Handset Selector Ring Proximal Pressure Tube TETEE ee hne rn EE ar z ee ee OO Patient i ita Enema Opening 2 ne orts i A E Therapy Gas Exhalation Orifice Nebulizer Page 18 2013 Hill Rom Services PTE Ltd ALL RIGHTS RESERVED The MetaNeb System Entrainment of Ambient Air 1 molecule of therapy Gas _ eee entrains 5 molecules Venturi Throat FDA 510 k Clearance to Market MetaNeb 4 0 Airway Clearance System Page 19 2013 Hill Rom Services PTE Ltd ALL RIGHTS RESERVED The MetaNeb System What Happens with Decreased Airway Compliance FDA 510 k Clearance to Market MetaNeb 4 0 Airway Clearance System Page 20 2013 Hill Rom Services PTE Ltd ALL RIGHTS RESERVED Pre Use Check Continu
11. ill Rom Services PTE Ltd ALL RIGHTS RESERVED pationts and thal caregivers The MetaNeb System In Line with Ventilator Protocol Make a note of the current ventilator settings Put a spring valve tee adapter into the inspiratory limb of the ventilator circuit Pt should be in a position to maintain head of bed angle at gt 30 degrees if possible Assess the breath sounds heart and respiratory rates Set the mode to CHFO and select Higher Sample Protocols are for information amp discussion purposes The health care team is responsible for selecting appropriate treatment for the patient Facilities are responsible for adopting their own protocols amp health care team should follow applicable facility protocols The MetaNeb System User Manual 174432 REV 1 page 16 17 Page 32 2013 Hill Rom Services PTE Ltd ALL RIGHTS RESERVED The MetaNeb System Circuit for in line use Remove selector ring Install black occlusion ring _ 4 Use the adaptor 15 mm X 22 mm to connect handset to the spring valve tee adapter Follow instructions stated in user manual The MetaNeb System User Manual 174432 REV 1 page 16 17 Page 33 2013 Hill Rom Services PTE Ltd ALL RIGHTS RESERVED 1 30 2014 11 The MetaNeb System Black Occlusion Ring Insert into spring loaded T piece adapter Page 34 2013 Hill Rom Services PTE Ltd ALL RIGHTS RESERVED The MetaNeb System In Line
12. inal Muscular Atrophy Pediatrics 2009 123 S245 S249 Page 7 2013 Hill Rom Services PTE Ltd ALL RIGHTS RESERVED Highlights of Healthcare Reform Passage of the Affordable Care Act Incentives and Penalties Individual Value Based Mandates and Purchasing Insurance Exchanges Department of Health and Human Services HHS gov HealthCare Enhancing outcomes for 2013 Hill Rom Services PTE Ltd ALL RIGHTS RESERVED patients ane thal corngivens Current Situation in the Acute and Extended Care Settings Financial impact of Value Based Purchasing days beyond DRGs The Healthcare Environment Today Increase scrutiny on transitions of care Page 9 2013 Hill Rom Services PTE Ltd ALL RIGHTS RESERVED 1 30 2014 Current Situation e Respiratory complications are a major concern Atelectasis appears in about 90 of all patients receiving general anesthesia amp may last several days May contribute to pulmonary complications Reimbursement environment is changing More focus on hospital acquired infections Growing awareness of prophylactic treatment of possible respiratory complications Muders T Wrigge H New insights into experimental evidence on atelectasis and causes of lung injury Best Prac Res Clin Anaesthesiol 2010 24 171 82 Page 10 2013 Hill Rom Services PTE Ltd ALL RIGHTS RESERVED Where We Have Been Patient effort dependent e Coughing and deep breathing e Ince
13. nd Clinic Journal Of Medicine Volume 76 Supplement 4 November 2009 4Lee K Rincon F Pulmonary Complications in Patients with Severe Brain Injury Critical Care Research and Practice Volume 2012 Article ID 207247 8 pages doi 10 1155 7 SBerlly M et al Respiratory Management During the First Five Days After Spinal Cord Injury J Spinal Cord Med 2007 30 309 318 Page 6 2013 Hill Rom Services PTE Ltd ALL RIGHTS RESERVED Identifying Patients at Risk Additional Risk Factors Patients with Chronic Disease e Chronic Lung Disease such as 1 COPD Asthma Cystic Fibrosis Bronchiectasis e Chronic Neurologic Diseases Diseases of the neurologic system including brain spinal cord motor nerves and muscles may lead to e Respiratory muscle or diaphragm dysfunction e Spinal thoracic deformity e Hypoventilation Ineffective cough e Bulbar dysfunction e Dysphasia and aspiration 1Yoder MA et al Perioperative Pulmonary Management August 15 2011 available at http emedicine medscape com article 284983 overview aw2aab6b4 2Chang AB Bilton D Exacerbations in cystic fibrosis 4 Non cystic fibrosis bronchiectasis Thorax 2008 63 269 276 doi 10 1136 thx 2006 060913 3Benditt J Boitano L Pulmonary Issues in Patients with Chronic Neuromuscular Disease American Journal of Respiratory and Critical Care Medicine Vol 187 No 10 2013 ppat04611055 4Schroth M Special Considerations in the Respiratory Management of Sp
14. ntive Spirometry Devices Some require patient effort May be difficult to combine therapies Disposable options not always CWEIIEIJ G Not all can be used with mechanical ventilation 12 position CPT e To treat all lobes of the lungs e Positions should be held for 3 to 15 minutes 12 positions X 3 minutes 36minutes 12 positions x 15 minutes 180 minutes e Percussion e Vibration 1Bronchial Hygiene Guidelines Committee American Association for Respiratory Care AARC clinical practice guideline postural drainage therapy Respiratory Care 1991 36 1418 1426 Page 11 2013 Hill Rom Services PTE Ltd ALL RIGHTS RESERVED Challenges in Current Practice Increasing demand for services Shortage of respiratory therapists Sicker and larger patients Multiple treatments devices often required to meet all of patient s needs Multiple treatments may be time consuming and tiring for patients Patient effort cooperation may be difficult if patient isn t able to Understand and follow directions too young too old or confused Control their breathing may be short of breath Page 12 2013 Hill Rom Services PTE Ltd ALL RIGHTS RESERVED 1 30 2014 The MetaNeb Systems Description The MetaNeb 3 0 System The MetaNeb 4 0 System KES 7 oR The MetaNeb Systems are u therapeutic devices that use a systematic approach to enhance normal mucus clearance and resolve or prevent atele
15. s effectively managed with The MetaNeb System HD 18 treatments were given every 2 3 hours for 10 mins each Within 4 hours of starting the every 2 hour treatments her atelectasis partially improved Patient did not need re intubation Her atelectasis completely resolved by HD 21 Discharged home HD 25 with no further respiratory complications Example of Toxic Epidermal Necrolysis http www bing com images search q free pictures of ToxictEpidermal Necrolysis amp qpvt free pictures Page 45 2013 Hill Rom Services PTE Ltd ALL RIGHTS RESERVED 15 1 30 2014 New Literature on The MetaNeb System The MetaNeb System in an Acute Care Hospital Setting An Assessment of Impact on Hospital Length of Stay Using A Failure Mode and Effects Analysis Travis Grasley RCP MA RRT Mercy Tiffin Hospital A 3 month evaluation January to March 2012 to determine the impact of The MetaNeb System in hospitalized patients with pneumonia amp other infiltrates e Comparison of the average LOS for 11 patients in The MetaNeb System treatment group 11 patients in the retrospective study group with an identical diagnosis e The MetaNeb System patients received aerosol and alternating 2 mins of CHFO and CPEP for a total treatment time of 8 mins Results e The mean LOS observed to expected OE ratio was calculated for each group Mean LOS OE ratio in The MetaNeb System group was 0 807 0 502 Mean LOS OE ratio in the
16. scopic surgery CHFO therapy with bronchodilators was administered every 4 hours via the MetaNeb System During the treatments patient expectorated large amounts of tenacious secretions Within 8 hours of initiation of therapy amp after only 2 treatment sessions improvement in breath sounds oxygen decreased to 6 Lom while maintaining SpO2 of 97 100 Ensuing chest x rays revealed improved aeration CHFO bronchial hygiene therapy continued for the duration of the patient s stay in the ICU Progressive improvement in the patient s pulmonary status was documented Page 46 2 Enhancing outcomes for 2013 Hill Rom Services PTE Ltd ALL RIGHTS RESERVED z patients and thew caregivers 14 1 30 2014 Literature On The MetaNeb System In line Application Aggressive Pulmonary Secretion Clearance Intervention In a Long Term Care LTC A Treatment Protocol Using The MetaNeb System Select Specialty Hospital Houston LP Houston TX Hill Rom Respiratory Care ADVANCE FOR LONG TERM CARE MANAGEMENT 2011 BY ELIZABETH COLEMAN BSM RT BRIAN BECKER MED RRT Intubated or trached patients on mechanical ventilation received The MetaNeb System every 6 hours through the ventilator circuit for 10 minutes Continue until weaned from mechanical ventilation then every 6 to 8 hours until decannulation or until discharge Generally patients continue to require airway clearance after decannulation The MetaNeb System ma
17. t position Largest opening with least resistance 2 dot position Smaller opening provides more resistance 3 dot position Smallest opening provides most resistance Use with mouthpiece face mask or tracheostomy adaptor The MetaNeb System User Manual 174432 REV 1 page 12 14 Page 29 2013 Hill Rom Services PTE Ltd ALL RIGHTS RESERVED MetaTherapy Treatment Protocol Delivering a MetaTherapy Treatment 1 Begin with CPEP Mode Adjust flow and selector ring to patient comfortable needs Continue CPEP Mode 2 minutes Move the Higher Lower dial to Higher Change mode to CHFO Mode Higher Lower dial may be moved to Lower to lower percussion rate and pressure if needed Continue CHFO Mode for 2 minutes Alternate between CPEP and CHFO every 2 1 2 mins Continue for 10 minutes or until neb empty When treatment complete turn unit off disconnect circuit and store Sample Protocols are for information amp discussion purposes The health care team is responsible for selecting appropriate treatment for the patient Facilities are responsible for adopting their own protocols amp health care team should follow applicable facility protocols The MetaNeb System User Manual 174432 REV 1 page 12 14 Page 30 2013 Hill Rom Services PTE Ltd ALL RIGHTS RESERVED 1 30 2014 10 The MetaNeb System In Line with Ventilator Protocol Page 31 Enhancing outcomes for 2013 H
18. ting appropriate treatment for the patient Facilities are responsible for adopting their own protocols amp health care team should follow applicable facility protocols The MetaNeb System User Manual 174432 REV 1 page 16 17 Page 36 2013 Hill Rom Services PTE Ltd ALL RIGHTS RESERVED 1 30 2014 12 1 30 2014 The MetaNeb Systems Absolute Contraindications Relative Contraindications Possible Adverse Reactions Untreated tension History of pneumothorax Hyperventilation pneumothorax Pulmonary air leak Gastric distension Untrained or unskilled Operator Recent pneumonectomy Decreased cardiac output Pulmonary hemorrhage Increased intracranial Myocardial infarction pressure Vomiting Increased air trapping Hyperoxygenation Pneumothorax Pulmonary air leak Pulmonary hemorrhage The MetaNeb System User Manual 174432 REV 1 page 2 Page 37 2013 Hill Rom Services PTE Ltd ALL RIGHTS RESERVED The MetaNeb System Cleaning and Disinfecting e Cleaning the circuit To help prevent cross contamination replace the SPU circuit between patients Replace circuit between patients when damaged or when visibly soiled Do not disinfect or sterilize the circuit for reuse with more than one patient The circuit is intended for a maximum use of 30 treatments or 7 days of use e Cleaning the Controller and Stand Wipe down the controller and st
19. with Ventilator Protocol During the Treatment Proceed with the CHFO in line therapy for approximately 10 minutes There is no need for CPEP as this therapy is accomplished with the ventilator Monitor the patient s responsiveness to treatment Adjust ventilator alarms as necessary during therapy Suction secretions as necessary during treatment Do not leave the patient during the therapy and be prepared to suction As secretions mobilize it is not uncommon for plugs to momentarily occlude the upper airways Sample Protocols are for information amp discussion purposes The health care team is responsible for selecting appropriate treatment for the patient Facilities are responsible for adopting their own protocols amp health care team should follow applicable facility protocols The MetaNeb System User Manual 174432 REV 1 page 16 17 Page 35 2013 Hill Rom Services PTE Ltd ALL RIGHTS RESERVED The MetaNeb System In Line with Ventilator Protocol Post Treatment e Remove the handset cap the spring valve tee adapter then turn the master switch OFF Empty medication from nebulizer and store in accordance with institutional protocol Return the ventilator alarms and mode to their previous settings Monitor and document the patient s tolerance during and after the treatment HR Sp02 Bp Auscultation Sample Protocols are for information amp discussion purposes The health care team is responsible for selec
20. y be used in these patients or sometimes changed to another modality such as HHCWO Quality improvement results Weaning percentage Decreased bronchoscopies Page 43 2013 Hill Rom Services PTE Ltd ALL RIGHTS RESERVED New Literature on The MetaNeb System Chest High Frequency Oscillatory Treatment for Severe Atelectasis in a Patient with Toxic Epidermal Necrolysis TEN Shiara Ortiz Puois MD Laura P Boshini MD Kathy A Short RRT RN James Hwang MD Bruce A Calms MD Samuel W Jones MD Journal of Burn Care amp Research March April 2013 Volume 34 Issue 2 p doi 10 1097 BCR 0b013e318257d83e e 17 year old girl developed Toxic Epidermal Necrolysis involving gt 80 of total body surface Electively intubated for pain and wound management on HD 3 Developed a significant left sided atelectasis after extubation on HD 17 Example of Toxic Epidermal Necrolysis thttp www bing com images search q free pictures of Toxict Epidermal Necrolysis amp qpvt free pictures Page 44 2013 Hill Rom Services PTE Ltd ALL RIGHTS RESERVED New Literature on The MetaNeb System Chest High Frequency Oscillatory Treatment for Severe Atelectasis in a Patient with Toxic Epidermal Necrolysis TEN Shiara Ortiz Puois MD Laura P Boshini MD Kathy A Short RRT RN James Hwang MD Bruce A Calms MD Samuel W Jones MD Journal of Burn Care amp Research March April 2013 Volume 34 Issue 2 p doi 10 1097 BCR 0b013e318257d83e Wa
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