2001 OPEN FORUM Abstracts
IMPROVEDOXYGENATION AND CARBON DIOXIDE ELIMINATION IN AN ADULT PATIENT UTILIZING HIGHFREQUENCY OSCILATORY VENTILATION AND HELIOX.
Chuck ChristophRRT, Wendy Lalone RRT, Debra Pearson RRT, and Jeffery Attwood RRT, ClarianHealth Partners, Indianapolis, Indiana. Philip Gibbs MD, Department of AnesthesiaCritical Care Indiana University School of Medicine.
Introduction: Forseveral years, HFOV has been used successfully in the neonatal and pediatricpatient populations. In addition, anecdotal cases have been reported where HFOVhas been utilized in adults weighing >100 kg with favorable results. Onepossible consequence of using HFOV on larger patients is the ineffective eliminationof carbon dioxide. Studies have shown that breathing a helium-oxygen mixture(Heliox) can improve ventilation and increase the removal of carbon dioxide.This case report illustrates the use of a SensorMedics 3100A HFOV in combinationwith Heliox to sufficiently ventilate an adult patient suffering from ARDS.
Summary: A 47year old with a seven-day history of mechanical ventilation and necrotic pancreatitiswas transported from an outlying hospital to our facility secondary to continueddeterioration of respiratory status. He was placed on a Servo 300A and requiredmultiple ventilator adjustments including inverse I:E ratio and optimal PEEPstudies in an attempt to improve oxygenation. His pulmonary condition continuedto worsen despite increases in FiO2, rate, and Peep. The decision to try HFOVwas made. A cylinder containing an 80/20 helium-oxygen mixture was on standby if needed to decrease the CO2. Patient was placed on HFOV with a resultantincrease in PaO2; however, PaCO2 increased (108mmHg) despite adjustments toDelta P, frequency, and Inspiratory Time. Heliox was initiated resulting ina 30% decrease in PaCO2. Patient was stabilized with settings of MAP=20, DeltaP=54, FiO2 0.70, frequency 3Hz, and Inspiratory Time 33%. Oxygenation improvedallowing the FIO2 and MAP to be decreased. Improved oxygenation allowed foran increase in the delivered helium percentage resulting in further decreaseof the PaCO2. The following chart illustrates a sample of ABG?s and select ventilatorparameters obtained before and during several days of HFOV and Heliox therapy.The following chart illustrates a sample of ABG?s obtained before and duringseveral days of HFOV and Heliox therapy.
|HFOV- 15 minutes||7.35||61||73||1.00||33||40||6 Hz|
|HFOV - 2.5 hrs||7.13||108||84||0.90||33||30||4 Hz|
|Heliox - 2 hours||7.26||76||58||0.90||33||30||4 Hz|
|Heliox - 5 hours||7.32||72||60||0.72||33||20||4 Hz|
|Servo 300 - <48hrs||7.46||44||46||1.00||1.5:1||21||15|
|HFOV/Heliox >6hrs||7.44||62||68||0.94||33||14||3 Hz|
|Heliox ? 11 days||7.60||32||58||0.32||33||22||3 Hz|
After 11 days, the patientwas removed from HFOV and Heliox and placed on conventional ventilation withoutdifficulties.
Discussion:In this patient, HFOV was effectively used to improve oxygenation and with theaddition of Heliox, was able to drastically lower the PaCO2 while producingno serious effects on machine function. More research is required to determinewhich patients might benefit from this therapy.