The Science Journal of the American Association for Respiratory Care

1998 OPEN FORUM Abstracts

CASE STUDY EXAMINING RESPONSE TO BRONCHODILATORS USING VENTILATOR GRAPHICS AND MECHANICS IN A PREMATURE.

John Emberger BS RRT, Mike Western RRT PPS, Sean Motoyoshi RRT, Dave Lapham BS RRT, Robert Locke DO, Departments of Respiratory Care and Neonatology, Christiana Care Health System, Newark, Delaware.

Introduction: The use of bronchodilators for premature infants requiring prolonged mechanical ventilation has increased. Our experience with bronchodilators in ventilator dependent premature infants is that a percentage have significant response. Methods of determining the efficacy of bronchodilators in premature infants have been documented using adjunct spirometry equipment. This case demonstrates the use of "live" ventilator graphics by Respiratory Care Practitioners (RCP) to assess response to a bronchodilator in a premature infant. Case Summary: This is the case of a 28 week gestation female premature infant. The patient was ventilator dependent for approximately seven weeks after birth. Bronchodilators were started on the fifth week after birth. The ventilator Flow/Volume loop shown here demonstrates the pre and post albuterol treatment (Ventilator settings: SIMV, PIP = 26 cmH2O, PEEP = 5 cmH2O, and set rate = 30 breaths/minute).

Table: Ventilator mechanics values for the above Flow/Volume loop:

Pre- Post-

Treatment Treatment

dynamic compliance (ml/cmH2O) 0.4 0.7

peak resistance (cmH2O/L/second) 1280 609

peak exhalation flow (ml/second) 42 53

mechanical tidal volume (ml) 8 15

Discussion: This is the case of a premature infant that has dramatic changes in both graphics and mechanics before and after albuterol treatments. With utilization of the graphics and mechanics that are on the ventilator, RCP's may be able to help determine which patients may benefit most from bronchodilators and which patients seem to not respond to bronchodilators. This may help decrease inappropriate treatments for patients with no response and could help decrease ventilator days in those with response without the use of adjunct spirometry equipment.

(See Original for Figure)

The 44th International Respiratory Congress Abstracts-On-DiskĀ®, November 7 - 10, 1998, Atlanta, Georgia.

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