1995 OPEN FORUM Abstracts
Bicore: An Efficient, Cost-Effective, Non-Invasive Weaning Tool
Theresa Ryan Schultz, BA, RRT, P/P Spec., Linda Allen Napoli, BS, RRT, RPFT, P/P Spec., Lorraine F. Hough, MEd, RRT, P/P Spec., Rodolfo I. Godinez, MD, PhD, The Children's Hospital of Philadelphia, Philadelphia. PA
PATIENT DATA AND CASE SUMMARY: A five week old patient with a history of periodic breathing and gastroesophogeal reflux was transferred from an outlying institution after a one week hospitalization. She had developed URI symptoms and had increased episodes of apnea requiring vigorous stimulation and FiO_2 1.0. According to serial blood gas analysis the patient progressed to respiratory failure and required tracheal intubation. The patient was placed on pressure pre-set ventilation (PIP 25, PEEP 4, RR 40, FiO_2 1.0). Arterial blood gas analysis revealed 7.29/58/73/27. The IMV rate was increased to 50 breaths per minute and the patient was transferred to our institution within two hours. The chest reoentenogram obtained in our Pediatric Intensive Care Unit revealed an endotracheal tube in good position, diffuse peribronchial thickening, atelectasis at both bases, right upper lobe opacity which may represent atelectasis or an infiltrate, no pleural fluid. The baby continued on current settings. (PIP 28, PEEP 4, RR 50). FiO_2 was weaned to .5. Pulmonary Function Testing done with the BICORE revealed lung overdistention. The BICORE is a non-invasive ventilation assessment tool designed for monitoring specific pulmonary mechanics. Although exhaled tidal volumes were within target range (8-10 ml/kg), flow waveform analysis and pressure-volume loops indicated that the patient's lungs were overdistended. Interpretation of time constants demonstrated that lung hyperinflation was related to insufficient expiratory time. The decision was made to wean the patient. Supported by pulse oximetry and ventilation assessment via the BICORE, the patient's preset RR was successfully weaned in decrements of 10 breaths per minute. The patient was extubated and placed into an oxygen hood at .3 FiO_2 by 1330 that same afternoon, without any need for further escalation of support. SIGNIFICANCE OF THE CASE: Along with physical assessment, this patient was monitored non-invasively with the BICORE Pulmonary Function Machine and pulse oximetry. These methods proved to be an efficient, non-invasive, cost-effective means of managing this patient.