The Science Journal of the American Association for Respiratory Care

2002 OPEN FORUM Abstracts

EVALUATION OF NEONATAL TIDAL VOLUMES USING THE FLORIAN GRAPHICS MONITOR.

Brian Glynn, BS RRT. Raymond Malloy, BS RRT,William Bucher RRT,Thomas H. Shaffer PhD, Wendy S. Sturtz, MD, Suzanne M. Touch, MD, Jay S. Greenspan, MD. Departments of Pulmonary Care and Neonatology, Thomas Jefferson University Hospital (TJUH), Philadelphia, Pa.

BACKGROUND: At TJUH, the Sensormedics 3100A High Frequency Oscillator (HFOV) is used to improve ventilation and oxygenation in neonates with respiratory failure who have not responded to conventional modalities. To optimize lung protective strategies, the goal is to achieve tidal volumes of 4-6ml/kg and these are conventionally thought to be less than physiologic dead space volume. As the Sensormedics 3100A Oscillator does not have in-line monitoring, an external monitor was utilized to track the infants? tidal volumes during routine care, and these values were compared.

HYPOTHESIS: This study was an attempt to validate that tidal volumes are less than dead space volume.

Methods: Five infants on the Sensormedics 3100A HFOV with chronic lung disease and without air leak were monitored. Tidal volume and tidal volume per kg were recorded using hot-wire anemometry (Florian: Acutronic Medical Systems). The range of HFOV settings were MAP (12-19 cm H2O), amplitude (18-40 cm H20), f (8-12 hz), and inspiratory time (0.33).

Results:

pt weight (kg) mean tidal volume(ml) mean tidal volume/kg estimated physiologic
tidal vol.
estimated dead
space vol.
1 1.1 2.9 2.84 8.25 2.75
2 0.96 2.61 2.72 6.72 2.24
3 0.84 2.63 3.13 6.3 2.1
4 1.19 1.96 1.65 8.92 2.97
5 1.04 3.37 3.24 7.8 2.6
  estimated physiologic tidal volume-7-8 ml/kg
  estimated dead space volume-1/3 of physiologic(2.5 ml/kg)

CONCLUSION: The above data indicates that measured tidal volume/kg during HFOV is equivalent to if not greater than expected dead space volume in 4 out of 5 patients. Although the tidal volumes are greater than dead space volume, the tidal volumes remain below the goal of 4-6ml/kg to achieve optimal lung protective strategies. The Florian Graphics Monitor may be useful in optimizing ventilation during oscillation, and may be useful in reducing the need for arterial blood gas draws to assess ventilator-patient interaction.

OF-02-108

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