1995 OPEN FORUM Abstracts
NASAL ASSIST CONTROL VENTILATION IN THE POSTOPERATIVE CARE OF CHILDREN WITH CONGENITAL HEART DISEASE
Douglas E. Petsinger, B.S., R.R.T. and Angel R. Cuadrado, M.D. Egleston Children's Hospital at the Emory University, Atlanta, Georgia
INTRODUCTION: Tracheal intubation and mechanical ventilatory support are routine in the postoperative care of children recovering from surgical repair of congenital heart disease. Nasal Assist Control Ventilation (NACV) can be a novel bridge from mechanical ventilatory support to supplemental oxygen therapy in their postoperative period. METHOD: A nasal pharyngeal tube was used as the airway during NACV (Portex Inc., Wilmington, MA). NACV was achieved with the Star Sync Patient Triggered Interface and either the Infant Star 200 or 500 mechanical ventilators (Infrasonics Inc., San Diego, CA). With StarSync in the assist/control mode, the ventilators were triggered to give a pressure-limited breath with each spontaneous breath as determined via the Star Sync abdominal pressure transducer. The settings used were a: PIP of 16 to 18 cmH_2O, PEEP of 6 to 8 cmH_2O, flow of 20 ± 5 LPM, FiO_2 of 0.21 to 0.40, IT to match the Star Sync spontaneous displayed value and a backup rate of 20 BPM. Once PEEP wasɠ cmH_2O, weaning from NACV was attempted by reducing PIP as tolerated (lack of tachypnea and retractions). A period of nasal CPAP was used prior to removing the nasal pharyngeal airway and low-flow nasal cannula oxygen therapy or room air followed.
Results: NACV was used on 16 children with evidence of impaired ventilatory function, i.e., > 10 days post-operative mechanical ventilatory support with tachypnea, retractions and a spontaneous V_T ofɝ cc/kg on pressure support (Servo 300 or 900C, Siemens-Elema, Danvers, MA). Two children had diaphragmatic hemiparesis. Heliox was added to NACV in three children with severe airway stridor unresolved with aerosolized racemic epinephrine and intravenous Decadron. Patients were< = 6 kg in weight and were recovering from a sternotomy approach complex cardiac repair (e.g., Norwood stage 1) or cardiac transplant. NACV was used for 6 ± 4 days with successful weaning in all cases.
Conclusions: Nasal Assist Control Ventilation is a novel bridge between mechanical ventilation and unassisted ventilatory support. NACV has been used successfully in the postoperative care of children recovering from surgical correction of complex heart defects.