2000 OPEN FORUM Abstracts
ALADDINII NCPAP SYSTEM WITH HELIOX DECREASED RESPIRATORY DISTRESS AND PREVENTED INTUBATION IN AN INFANT WITH RSV BRONCHIOLITIS
Melissa K. Brown RRT, Susan E. Duthie M.D., Department of Critical Care, Children's Hospital and Health Center, San Diego, California
Introduction: Nasal Continuous Positive Airway Pressure (NCPAP) has been available in Neonatal and Pediatric ICUs for many years. Many of the devices require the infants to expend a significant amount of ventilatory work to exhale against the CPAP flows. Often the devices do not meet the infants inspiratory demand needs due to inadequate flow. The ALADDINII system (Hamilton Medical, Reno, NV.) is designed for active NCPAP delivery through its Universal Generator. The ALADDINII utilizes the Bernoulli effect and dual injector jets directed toward each nasal passage to maintain a constant NCPAP pressure. If additional flow is needed by the infant the Venturi action of the jets will entrain additional flow. The infant can exhale without additional work due to the flow pressure stalling effects on the dual injector jets. Continuous positive pressure is maintained throughout the respiratory cycle by a residual gas pressure. Helium is a low density gas. When used in combination with oxygen (heliox), its ability to decrease work of breathing in patient's with Respiratory Syncytial Virus (RSV) bronchiolitis is being documented with increasing frequency. A small percentage of patients with RSV will still require intubation after heliox therapy is initiated. This case study examines the benefit of adding heliox to the improved NCPAP system provided by the ALADDINII. Case Summary: The patient was a previously healthy eight week old, 5.5 kg male. He had a one week history of upper respiratory tract infection symptoms. The mother reported the child was blue at home and having periods of apnea. The infant was transported via ambulance to an outlying facility. The Children's Hospital of San Diego (CHSD) transport team assessed the child and found him to be in severe distress and near respiratory failure. He was subsequently transported to the CHSD PICU. He was placed on the ALADDINII Nasal CPAP system with a CPAP of 5. The patient had a dramatic decrease in work of breathing as evidenced by decreased use of accessory muscles, decreased respiratory rate and resolution of grunting. The patient still had significant respiratory distress and tachypnea, therefore heliox (70% helium, 30% oxygen) was added two hours later with further clinically significant improvement in respiratory status. CXR was consistent with bronchiolitis and the patient was found to be RSV positive. After 36 hours the NCPAP was discontinued. Heliox therapy was maintained for 2 additional days. The patient was discharged home two days after the heliox was discontinued. Discussion: The ALADDINII with heliox had a dramatic effect on this patient's work of breathing. Intubation and possibly a prolonged ventilated PICU course was avoided. The benefit of NCPAP in the neonatal population is well documented. There are many studies showing heliox can improve ventilation of infants with RSV. More research is required to see if active NCPAP used in combination with heliox will decrease intubation rates for RSV bronchiolitis.