Airway Clearance Techniques in the PICU

This podcast addresses airway clearance in critically ill pediatric ICU patients, emphasizing pharmacological and non-pharmacological techniques. The discussion covers normal pulmonary secretion clearance involving the mucociliary escalator and effective coughing, contrasting this with compromised mechanisms due to neuromuscular diseases or mechanical ventilation. Atelectasis, defined as imperfect lung expansion, is examined, detailing its mechanisms—surfactant, collateral ventilation, and lung-chest wall balance—and various types including resorption atelectasis from high FiO2. The hosts explore treatments like suctioning, postural drainage, chest physiotherapy, and devices such as incentive spirometry and intrapulmonary percussive ventilators, alongside pharmacological options like saline, hypertonic saline, N-acetylcysteine, and Dornase Alpha, also considering the role of bronchoscopy and strategies for patients on high-frequency oscillatory ventilation.