IMPACT OF MECHANICAL PERCUSSOR ON REOPENING COLLAPSED LUNG IN FEMALE DIAGNOSED WITH LABIAL TEAR IN CRITICAL CARE UNIT- A CASE REPORT

Abstract

Background: Rapid advancements in physiotherapy within critical care have led to the implementation of mechanical devices that support airway clearance while minimizing therapist fatigue and patient discomfort. Mechanical percussors provide controlled, consistent chest wall oscillations and may be particularly beneficial for patients who cannot tolerate manual percussion. Evidence remains limited regarding their use in patients experiencing severe pain, such as those with labial tears. Case Presentation: This case report describes a 75-year-old female with diabetes, hypertension, prior breast cancer surgery, and an acute labial tear who was admitted to the ICU with fever, swelling, and generalized weakness. During her stay, she developed secretion retention and progressive respiratory deterioration leading to left lung collapse. Laboratory findings revealed elevated and deranged lab values, metabolic acidosis, hypoxemia, and left lung collapsed on imaging. Manual chest physiotherapy, including huffing, coughing, counter-stretches, and deep breathing, was not much effective due to pain and poor tolerance. Intervention: To avoid worsening pelvic and thoracic pain, a mechanical percussor was applied in the left lung postural drainage position at 20–30 Hz, three times daily. This intervention was selected based on evidence supporting its safety, controlled frequency, and improved comfort compared to manual techniques. Results: Significant improvement was observed after four days of mechanical percussion. SPO₂ increased from 88% (on 4 L oxygen) to 96%, respiratory rate normalized from rapid shallow breathing to 18 breaths per minute, and breath sounds returned in the left lung. Arterial oxygenation improved markedly (PaO₂ from 56 to 106 mmHg). Chest X-ray demonstrated restored aeration, and dyspnea reduced from mMRC grade 4 to grade 1. The intervention was well tolerated and did not provoke pain or hemodynamic instability. Conclusion: Mechanical percussion effectively reopened a collapsed lung in a critically ill patient with a labial tear who was unable to tolerate manual percussions. The device facilitated secretion mobilization, improved lung expansion, and reduced dyspnea, offering a safe and patient-friendly alternative to traditional chest physiotherapy. These findings support the integration of mechanical percussors in ICU physiotherapy practice and highlight the need for future large-scale studies and randomized controlled trials.