2001 OPEN FORUM Abstracts
APROSPECTIVE RANDOMIZED COMPARISON OF THE VOLUME DIFFUSIVE RESPIRATOR®(VDR) VS. CONVENTIONAL VENTILATION FOR TREATMENT OF BURNED CHILDREN
BradCarman, RRT, Thomas Cahill, RRT, Glenn Warden, MD, John McCall, MD Shriners Hospital for Children, CincinnatiBurns Hospital
Introduction:The Volume Diffusive Respirator® (VDR) (Percussionaire, Sandpoint,ID) is a high frequency time cycled pressure ventilator that can ventilate,oxygenate, and promote secretion removal. The VDR produces lower airway pressurescompared to conventional ventilation in the pressure control mode (CV). TheVDR has been reported to be advantageous in retrospective studies. A prospective,IRB approved study was conducted comparing the VDR to CV in burned childrento assess outcomes such as ventilator settings, ventilator days, pneumonia,and barotrauma.
Methods: Pediatricburn patients requiring ventilation were stratified by presence of inhalationinjury and ventilated by VDR or CV to achieve predefined arterial blood gases.The data recorded included age, cause of burn, total body surface area burned(%TBSA), best P/F ratio, number of ventilator days (vent days), maximal peakinspiratory pressure (PIP)/amplitude, incidence of barotrauma, pneumonia, respiratorydistress syndrome (RDS), sepsis, and survival.
Results: Sixty-fourpatients were prospectively assigned ventilator type; 32 to VDR, 32 to CV. Datareported as mean ± SEM. Patient age was 7.4±0.7 yrs, TBSA was 56±3%, and numberof inhalation injuries was 55 (86%). Multiple logistic regression analysis revealedthe maximum PIP (cm H2O) with the VDR was significantly less thanwith CV (30.9±0.8 vs. 39.5±1.8 p<0.05) and the best P/F ratio was significantlyhigher with the VDR compared to CV (563±15 vs. 507±13 p<0.05). No patientin the VDR group had evidence of barotrauma compared to two in the CV group.Five patients in the CV group expired compared to two in the VDR group.
Conclusion: Patientsventilated with the VDR required significantly lower PIP than with PCV. Patientsachieve a significantly higher P/F ratio on the VDR when compared to conventionalpressure control ventilation. This demonstrates the VDR is a safe and effectivemethod of ventilation for pediatric burn patients and it offers advantages whencompared to conventional ventilation.