Oscillation and Lung Expansion Therapy as Rescue Airway Clearance in Critically Ill Adults: A Case Series.

introductionRetained airway secretions and lobar collapse are common in hospitalized adults with advanced lung disease. Conventional airway clearance depends on respiratory effort, requiring both an adequate inspiratory volume and sufficient expiratory airflow, and on cough strength, and therefore fails most often in the patients who need it most. Oscillation and lung expansion (OLE) therapy delivers continuous positive expiratory pressure (CPEP), continuous high-frequency oscillation (CHFO), and aerosolized medication in a single 10-min treatment, but reported experience is largely confined to postoperative prophylaxis and the home setting.

methodsWe describe six consecutive adults (aged 18-77 years) treated with OLE (Volara system) at a Canadian tertiary center between March 2023 and April 2026, after conventional airway clearance had failed or after escalation to near-maximal noninvasive respiratory support. Feasibility (delivery of OLE as prescribed at the prevailing level of respiratory support) and tolerability (absence of adverse events or discontinuation for intolerance) were assessed retrospectively.

resultsDiagnoses were cystic fibrosis exacerbation (n = 2), thoracic malignancy with lobar collapse from mucus plugging (n = 2), metapneumovirus pneumonia in VEXAS (vacuoles, E1 enzyme, X-linked, autoinflammatory, somatic) syndrome (n = 1), and autoimmune pulmonary alveolar proteinosis with sepsis (n = 1). In each, the realistic alternatives were bronchoscopy, intubation, or palliation. All six demonstrated secretion clearance, radiographic re-expansion, or both. Supplemental oxygen requirements fell in five, two did not require the intensive care transfer or intubation that had been anticipated, and no adverse event was observed following OLE, including in one patient with a recently drained pneumothorax. One patient with metastatic malignancy died of her cancer during the same admission despite radiographic re-expansion.

conclusionsOLE was feasible and well tolerated when used as rescue airway clearance in high-acuity adults. These observations, while hypothesis-generating, require prospective, protocolized evaluation before OLE can be recommended for this indication.