The Science Journal of the American Association for Respiratory Care

1998 OPEN FORUM Abstracts

HIGH FREQUENCY OSCILLATORY VENTILATION IN ACUTE RESPIRATORY DISTRESS SYNDROME: AN ADULT CASE STUDY.

Michael A. Gentile, RRT, John M. Davies, RRT, Donna S. Tripp, RRT, Ira M. Cheifetz, MD, Joseph A. Govert, MD, Duke University Medical Center, Durham, NC.

Introduction: Patients with Acute Respiratory Distress Syndrome (ARDS) often have extremely poor gas exchange on conventional mechanical ventilation (CMV). There have been only anecdotal reports of the use of High Frequency Oscillatory Ventilation (HFOV) in adult patients.^{1} HFOV may provide a mode of ventilation that reverses atelectasis while avoiding overdistending of alveoli. Thus, secondary lung injury may be minimized by HFOV in patients with ARDS.

Case Summary: We are reporting the case of a 23 year-old female with a history of bulimia but without other significant medical history. She reported to the Emergency Department febrile with a chest radiograph that showed infiltrates in the left upper, left middle and right lower lobes. An arterial blood gas (ABG) drawn on room air revealed: pH 7.49, PaO_{2} 59 mmHg, and PaCO_{2} 25 mmHg. The patient was admitted with the diagnosis of Pneumococcal pneumonia. On day three of hospitalization, the patient required endotracheal intubation and CMV for respiratory failure. The patient's condition continued to deteriorate and by day 10, three pneumothoracies were present with significant air leaks from chest tubes bilaterally. Treatment included Pressure Control Ventilation (PCV), inhaled Nitric Oxide, and prone positioning. On day 19, ABG analysis revealed: pH 7.09, PaCO_{2} 200 mmHg, PaO2 46 mmHg, HCO3 62. These results were obtained on PCV rate 32, PEEP 14 cm H_{2}O, FiO2 70%, PIP 38 cm H_{2}O, mean airway pressure of 24 cm H_{2}O, and tidal volumes of 200-300 ml. The patient was placed on HFOV (Sensormedics 3100A, Yorba Linda, CA). The initial setting were FiO2 1.0, inspiratory time 40%, amplitude 62, frequency 5 hertz, and mean airway pressure 29 cm H_{2}O. Her ABG after three hours of HFOV was pH 7.39, PaCO_{2} 81mmHg, and PaO_{2} 125 mmHg. After 14 days of HFOV, the patient was returned to CMV and weaned. On day 66, the patient was discharged from the hospital.

Discussion: While HFOV in the adult population with ARDS is still in the developmental stages, this case demonstrates HFOV as an effective strategy in those patients who are failing CMV. Cases such as the one presented here indicate that a randomized controlled trial is warranted.

1. Fort P., et. al. Crit Care Med 1997.

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

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