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Patients receiving invasive mechanical ventilation frequently receive airway clearance therapies and are often prescribed inhaled medications.1-2 Ideally, being able to perform both activities concomitantly could result in valuable savings in respiratory therapist time. The intrapulmonary percussive ventilation (IPV) device combines a high-frequency percussive ventilator with a jet nebulizer. Previously, an adapter that was connected on one end to the endotracheal tube and on the other end to the inspiratory and expiratory limbs and the phasitron through different openings was used.3 However, the adapter was heavy and bulky, increasing the risk of an unplanned extubation event. The IPV device can also be attached to the endotracheal or tracheostomy following disconnection from the ventilator circuit. However, this practice would not be advisable in patients supported with high PEEP as it will result in lung de-recruitment.4 More recently, a new adapter that could be inserted between the inspiratory limb and the Y-piece connector became available.5
The use of in-line IPV as an airway clearance therapy in children and adults receiving mechanical ventilation showed improvement in oxygenation and in resolution of atelectasis.6,-,8 The use of IPV connected to the tracheostomy tube has also been reported to result in improvement of …
Correspondence: Ariel Berlinski MD FAARC, 1 Children’s Way, Slot 512–17, Little Rock, AR 72202. E-mail: BerlinskiAriel{at}uams.edu
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