The Science Journal of the American Association for Respiratory Care

1995 OPEN FORUM Abstracts

ADULT HIGH FREQUENCY IN ARDS; A REVIEW OF TWO CASES

N. Tate Bennett, RRT, Cape Fear Valley Medical Center, Fayetteville, N.C.

High F_{io2} and increased ventilating pressures are problems commonly associated with the care of ARDS patients. Clinical trials suggest that the use of High Frequency Ventilation (UHFV) may be beneficial. We examine two patients in ARDS ventilated with the Infrasonics Star 1010 High Frequency Ventilator after failing conventional mechanical ventilation.

A 31 year old female was admitted to the hospital with pelvic pain. She was diagnosed with pelvic inflammatory disease, sepsis, and ARDS. With an F_{io2} of 1.0 abg's revealed a P_{ao2} of 59 mmHg. After intubation and ventilation on pressure control ventilation and F_{io2} of 1.0 her P_{ao2} was 80 mmHg after 24 hours. Peak Airway Pressure (PAP) was 35 cmH20, Mean Airway Pressure (MAP) 21 cmH20, and PEEP 10 cmH20 on conventional ventilation at the time of the switch to UHFV. For the 24 hours prior to UHFV PAP was 34 ± 6 cmH20, MAP 20 ± 3 cmH20, and PEEP 9 ± 1 cmH20. She was placed on the Star 1010 and 1 hour later P_{ao2} was 182 mmHg. F_{io2} was decreased steadily and 24 hours after implementation of UHFV her P_{ao2} was 121 mmHg with an F_{io2} of .30. PAP was 35 cmH20, MAP 19 cmH20, and PEEP 7 cmH20 upon implementation of UHFV. Mean PAP was 33 ± 5, MAP 20 ± 3 cmH20, and PEEP 9 ± 1 for the 24 hours after UHFV. Five days after the implementation of UHFV the patient was extubated.

A 22 year old male presented with multiple rib fractures with flail chest, bilateral pneumothoraces, and pulmonary contusion. After intubation and conventional mechanical ventilation with an F_{io2} of 1.0 his P_{ao2} was 75 mmHg. PAP was 38 cmH20, MAP 23 cmH20, and PEEP 15 cmH20. For the period of time preceding UHFV mean MAP was 34 ± 3 cmH20, MAP 20 ± 3 cmH20, and PEEP 10 ± 1 cmH20. He desaturated acutely with accompanying bradycardia. He was placed on the Star 1010 and ABG 1 hour later revealed a P_{ao2} of 178 mmHg with an F_{io2} of 1.0. After implementation of UHFV initial PAP was 38 cmH20, MAP 24 cmH20, and PEEP 10 cmH20. For the 24 hours following implementation of UHFV mean PAP was 32 ± 4, cmH20, MAP 21 ± 2 cmH20, and PEEP 10 ± 4 cmH20. His condition stabilized and 24 hours after UHFV his P_{ao2} was 107 mmHg with an F_{io2} of .50. He continued to improve and was extubated nine days after admission to the hospital.

These patients appear to have benefitted from UHFV, but controlled studies are needed.

OF-95-019

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