The Science Journal of the American Association for Respiratory Care

1999 OPEN FORUM Abstracts

CASE STUDY USING HELIOX IN THE CYSTIC FIBROSIS PATIENT IN SEVERE RESPIRATORY DISTRESS

Larry Simpson BA, RRT, Clay Shaffer RRT, Joseph M. Majure MD. Duke University Childrens Medical Center, Durham, North Carolina.

Introduction: Heliox is used to treat the obstructed airway in the treatment of asthma. Therefore we theorized that the same therapy should work for the lung in cystic fibrosis that is hyperinflated and backed up with retained secretions. History: The patient is a 15 year old white female with a history of Cystic Fibrosis. The patient had been stable, with her most recent admission for respiratory problems 18 months previous to this clinic visit. Upon arrival to the clinic, a Vbg was obtained via a central line, VaO2 38, VCO2 32, Ph 7.42, and bicarbonate 32 on 100% FiO2. Her respiratory rate was in the 60's with accessory muscle usage. SpO2 on the 100% FiO2 was 88-90%. Pulmonary functions were FVC 19% and FEV1 16% of her predicted values and a RV/TLC ratio 85%. Chest radiograph was consistent with hyperinflation and the typical changes of cystic fibrosis. Sputum culture and sensitivity showed resistant Pseudomonas aeruginosa and Staphylococcus aureus. Initial therapy consisted of aerosolized bronchliators, IV antibiotics and IV steroids along with CPT. Case Study: The patient showed no signs of improvement after several hours of her initial therapy, her SpO2 was 85% on 100% FiO2 with a respiratory rate of 60. Heliox was started from a cylinder containing an 80% helium and 20 % oxygen mixture; additional oxygen was blended in to obtain a 40% helium and 60% oxygen mixture along with a 4 liter a minute nasal cannula Within a five minute period her SpO2 increased to 95%, her respiratory rate had dropped to the 40's, and she stated that she felt better. A second Vbg was obtained with a marked improvement in the VaO2 from 38 to 95 after one hour. Since her SpO2 increased, we used the pulse oximetry to wean the oxygen. The first wean was to the FiO2 mixture; then we reversed that move and weaned the cannula off within 3 hours of the initiation of heliox. The helium was at 70% and the oxygen was at 30% after 9 hours. Pulmonary function tests performed weekly for the next four weeks indicated an increase in FVC and FEV1 and a decrease in the RV/TLC ratio.

FVC FEV1 FEV1/FVC TGV RV TLC RV/TLC
Admission 19% 16% 82% 179% 380% 96% 85
Day 7 41% 25% 62% 158% 285% 96% 64
Day 14 50% 28% 57% 164% 290% 101% 62
Day 21 50% 33% 65% 154% 258% 96% 58
Day 25 51% 33% 64% 144% 223% 93% 52
Discharge 50% 35% 70% 144% 223% 90% 53

Conclusion: Heliox therapy seemed to be valuable to this patient with severe respiratory distress allowing lower oxygen concentrations and an increase in her sputum production.

OF-99-213

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