2002 OPEN FORUM Abstracts
PRELIMINARY EVALUATION AND APPLICATION OF THE DIAMETRICS NEOTREND-L CONTINUOUS BLOOD GAS MONITORING SYSTEM: A CASE STUDY
Suzanne M. Durning BS, RRT, Rodolfo Godinez MD, PhD, Linda A. Napoli, BS, RRT The Children?s Hospital of Philadelphia, Philadelphia, PA
This patient is a 3-kg. Baby girl with a diagnosis of single ventricle physiology with possible pulmonary atresia. She was admitted to our Cardiac Intensive Care Unit (CICU) at 12 hours of life. The initial ventilator settings were SIMV Pressure Preset mode, Rate of 16, Peak inspiratory pressure 26cmH2O, FiO2 .21, PEEP 5 cmH2O and Pressure Support of 5 cmH2O. The patient underwent cardiac catheterization on day two of life and was diagnosed with heterotaxy, asplenia, infradiaphragmatic total anomalous pulmonary venous return (TAPVR) and coarctation of the aorta. On day three of life, the patient was taken to the cardiac operating room for complex repair of TAPVR, pulmonary artery patch plasty, and placement of a central aorta to pulmonary shunt.
The patient had a 5.0 Fr. Neotrend-L compatible Argyle umbilical artery catheter placed intraoperatively and a Neotrend-L continuous blood gas monitoring sensor was inserted via the UAC postoperatively in the CICU. Multiple comparisons were made between blood gas results from the Blood Gas Lab and the Neotrend-L continuous blood gas monitor with comparable results. Postoperatively, the patient demonstrated a labile pulmonary vascular resistance, which was treated with mild hyperventilation and nitric oxide therapy to maintain adequate pulmonary blood flow.
Postoperatively, the patient?s mechanical ventilation was weaned by physician goal-directed orders for pH, PCO2 and PO2 utilizing the Neotrend-L monitor. In addition, continuous blood gas monitoring enabled us to expedite the process of weaning the patient from nitric oxide therapy
The Neotrend-L Continuous Blood Gas Monitor allowed the bedside clinicians to titrate the patient?s ventilator settings and nitric oxide therapy with ?real-time? results at the bedside. Further evaluation is needed to determine appropriate use and application of this technology in the pediatric population.
The Diametrics Continuous Blood Gas Monitoring System and technical support was provided by Philips Medical Systems.