This patient received a bone-marrow transplant on the third day of her ICU stay. Her minute ventilation requirement was 300 mL/kg/min and her Pao2/Fio2 was 64 at that time. Two days after admission, the patient became acidotic, and nasotracheal intubation was required. She was tachypneic, with a respiratory rate of 145 breaths per minute, and tachycardic, with a heart rate of up to 176 beats per minute. She required supplemental oxygen, delivered via tent at a fraction of inspired oxygen (Fio2) of 0.6. She was admitted to the pediatric ICU of The Childrens Hospital of Philadelphia, after she developed increased signs and symptoms of respiratory distress. The subject was a 5-month-old female with a history of hemophagocytic syndrome, pneumonitis, mucositis, graft-versus-host disease, peripheral edema, hypertension, urinary-tract infection, and poorly controlled pain. Furthermore, it has been reported 5 that continuous, automatic turning on an air-support surface is well tolerated by critically ill patients. 3 Investigators 3,4 have reported that continuous rotation (versus the more traditional intermittent turning of critically ill patients) was associated with significant reductions in atelectasis, pneumonia, time spent intubated, and the number of days spent in the ICU. Kinetic therapy is a means of redistributing blood flow to the lung in a way that enhances ventilation-perfusion matching. Strategies for minimizing secondary lung injury may benefit all patients with this disease. 2 The most common site of nosocomial infection acquired in the intensive care unit (ICU) is the respiratory system.

2 In 1991, United States health care costs for the treatment of nosocomial infection were $5 billion (109) to $10 billion, and nosocomial infection was directly linked to more than 80,000 deaths. The prevalence of nosocomial infection in hospitalized patients is approximately 6%, with a disproportionate 20% of these cases occurring in critically ill patients. 1 Prolonged immobility can lead to pneumonia (with increased morbidity, mortality, and economic burden). Although daily sleep and bed rest are critical to maintaining a normally functioning brain and musculoskeletal system, prolonged immobility can adversely affect not only these systems, but also the lungs the cardiovascular, gastrointestinal, and genitourinary systems and the skin. Even while asleep, they move approximately every 15 minutes. Healthy people spend most of the day in varying degrees of motion. Kinetic and percussive therapies were used to improve pulmonary outcomes of a 5-month-old patient with respiratory distress symptoms.

Dead space in lung advantage