1999 OPEN FORUM Abstracts

TRANSPORT HIGH FREQUENCY VENTILATION USING THE VDR-3C PERCUSSIONATORÒ.

Daniel Villareal R.R.T. and John Patrick Cleary M.D., Children's Hospital of Orange County, Orange, California.

Background - The Children's Hospital of Orange County (CHOC) transport team frequently transports infants and children with respiratory and or cardiac failure for HFOV, Nitric Oxide, and/or ECMO. Increasingly patients are receiving high frequency ventilation (HFV) at the time of referral or have a diagnosis which might benefit from high frequency ventilation. This trend led us to search for a ventilator which could deliver HFV during transport. We report our implementation of transport HFV and our experience to date.

The VDRÒ-3C Universal Logistical PercussionatorÒ (PercussionaireÒ Corp., Sandpoint, Idaho) was developed by DR. F.M. Bird and delivers HFV and/or Tidal Ventilation via a fully pneumatic system. It is FDA approved for use in preterm infants through adults. It's reliability was displayed during Operation Desert Storm where it was used routinely for transport and perioperative ventilatory management. After consultation with Dr. Bird (D.V.), the VDRÒ-3C was chosen as our transport ventilator. A unique oxygen supply cart and manifold was developed by D.V. This increased the duration of time the ventilator could be used without changing gas source.

Preparation - All transport personnel were inserviced on the features and indications for use of the VDRÒ-3C. Respiratory therapists received hands on in-hospital education and evaluation using the VDRÒ-3C prior to use during transport. A conventional transport ventilator has been brought on initial transports as a back-up should any deterioration with the VDRÒ-3C be seen. Trancutaneous CO2 monitoring is used routinely to minimize the incidence of hypocarbia. Continuous saturation monitoring is also employed.

Indications for use -The VDRÒ-3C is being used to transport any infant or child who is receiving HFV at the time that transport is requested. It is also used for infants who are failing conventional management, and those with diagnoses for which HFV is standard care such as air leak syndrome.

Experience to date - 7 transports have been performed using HFV. Cases have included: 2 term infants with sepsis/pneumonia. I term infant with MAS. 2 preterm infants with air leak syndromes (pulmonary interstitial emphysema and broncho-pleural fistula). I term infant with pulmonary hemorrhage and 1 three year old with ARDS.

Duration of return transport has ranged from 30 to 130 minutes. During one transport HFV was combined with N.O. therapy. In all cases to date the oxygen saturation during transport was either improved (5/7) or unchanged (2/7) when compared with the 1 hour prior to transport. Arterial blood gasses obtained upon arrival at CHOC have shown CO2 to be within clinical target range (30 to 50 torr) in all patients. This is the first program to use VDRÒ-3C HFV during transport of children in the U.S.

OF-99-112