The Science Journal of the American Association for Respiratory Care

2004 OPEN FORUM Abstracts

CASE STUDY: HFOV vs. PCV IN THE BARIATRIC PATIENT

Susan Adam, RRT, Derrick Orr, CRT, Albert Gutmaker, RRTIrving Cohen, RRT, NP.S, Noreen McIntyre, RRT Albert Einstein Medical Center, Philadelphia, PA

INTRODUCTION: The use of high frequency oscillatory ventilation (HFOV) is becoming a more acceptable mode of ventilation in the adult population Due to the increasing number of difficult to ventilate/oxygenate Gastric Bypass pts. We are presenting a case where there was significant improvement with HFOV vs PCV. Although the final pt. outcome was not as predicted, we did show the improvements with HFOV.

CASE SUMMARY:
The pt. was a 38 y/o morbidly obese white male. The pt. had Gastric Bypass surgery approx. 8 days prior to being readmitted for obstruction/dehissance. The pt. was taken to the OR to repair the open abdomen and remained intubated postop. Initial ABG revealed 7.35/35/52/19/84; Chest X-ray revealed questionable aspiration pneumonia. The pt remained on volume ventilation and at day 6, developed sepsis and subsequently went into ARDS. Pt overall condition continued to decline. ABG prior to HFOV was 7.50/41/63, on PC 30, Peep 15, 100% O2. Pt placed on HFOV with AMP 73/Hz 6/ Ti 33%/MAP35/ O2 100%. ABG 2H post, 7.13/105/113/34/96. Adjustments made were Hz3/ incr Ti 40%/ AMP 80, and a cuff leak were initiated. ABG 4H post 7.33/60/277. Oxygen weaned to 70% with an ABG of 7.37/55/182/32/100. Pt remained on HFOV for 4 days, MAP weaned to mid 30’s and 60% oxygen with ABG of 7.36/60/79/33/94. Pt changed to PCV, PC28/ Peep 15/ RR 15/ I:E 2:1/ O2 60%. ABG on PCV after 6 hours was 7.14/111/63/37/81. HFOV reinstituted and chest X-ray revealed R-sided pneumothorax. Chest tube was placed. Pt was able to be weaned over the next 5 days to Bilevel ventilation. Pts overall condition deteriorated and developed a cardiac arrest and expired

Conclusion:
We’ve concluded that HFOV is a safer mode of ventilation than PCV as evidenced by the fact that oxygenation/ventilation was better achieved with lower PIP’s.

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