New emergency procedure at GRMC saves a life

GRMC Pulmonologist Dr. Jose Gonzalez, PA Nicole Kitchen, Dr. Anna Shapiro, ICU Nurse Manager Joanna Villamayor, GRMC Pulmonologist Dr. Michael Agustin                                      

Recently, a patient was admitted to the Guam Regional Medical City intensive care unit with ARDS, the abbreviation for what's known as Acute Respiratory Distress Syndrome. He was suffering from a severe case of pneumonia and deteriorating rapidly. He was not responding to conventional treatments. He needed a very high concentration of oxygen to survive.

In an effort to save the patient’s life, GRMC Pulmonologist Dr. Jose Gonzalez decided on a procedure known as “Prone Position Ventilation”. It’s a rescue procedure that involves flipping the patient over and placing him in the prone position on the bed.

Dr. Gonzalez explains that in cases of ARDS “there are some areas of the lung that are very inflamed, and other areas that have not been affected. When you flip the patient, and place him in a prone position, you improve the aeration of those areas that are less affected.”

Although this procedure has been done at GRMC on a couple of occasions, said Dr. Gonzalez, it’s still rarely performed on Guam. He emphasizes that it can only be done with the help of an experienced team.

“The actual flipping of the patient is labor intensive,” said ICU Nurse Manager Joanna Villamayor. “It requires teamwork from all of the nurses. The other half is the monitoring and continuing assessment of the patient.” The patient was placed under close observation in the GRMC ICU unit. The GRMC Respiratory staff watched his progress closely, changing his intubation tubes and breathing position as required.

“We were able to get the breathing tube completely out and get him breathing completely on his own” said Dr. Anna Shapiro who, together with Dr. Pei-Chang Liu, monitored the patient day and night. “This patient wasn’t doing very well when he first arrived,” said Physician Assistant Nicole Kitchen. “Once this procedure was done, there was marked improvement.”

After two days in the prone position, the patient’s ability to breath was significantly improved and he was soon discharged. “The patient is now home, breathing on his own and he does not require any support,” said Dr. Gonzalez.

“It’s not a one man team, it’s a collaborative effort” said GRMC Pulmonologist Dr. Michael Agustin. “You can count on the GRMC ICU and Respiratory teams to support your loved ones during trying times.”

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