2004 OPEN FORUM Abstracts
Adult High Frequency Oscillatory Ventilation in a Community Hospital Setting A Case Series
NA
Widder, RRT-NPS, FJ DeMarco, MD, FCCP, DR Turner, RRT. Gwinnett
Medical Center, Lawrenceville GA
In November
2001, the FDA approved the sale of the Sensormedics 3100B ventilator.
The 3100B is used to provide High Frequency Oscillatory Ventilation
(HFOV) to patients weighing more than 35kg. In March 2002, Gwinnett
Medical Center (GMC) initiated HFOV on its first adult patient. To
date, GMC has provided this service to 20 different patients, for a
total of 23 separate runs of HFOV.
This is a
retrospective study of the 13 available medical records of the adult
HFOV patients cared for at GMC.
Background: GMC is a 200-bed community hospital with an integrated
Level II Trauma center. It has a 20-bed ICU, a six bed Neuro-ICU, and a
Respiratory Care Department with 51 FTE’s. GMC also has a 36-
bed Level III NICU with many years of infant HFOV experience. There
are two 3100B clinical specialists on staff at the facility.
Sex:
Male: 11
Female: 2
Age:
Range:14 to 80 years
Mean: 41.6
years
Diagnosis:
Trauma: 7
Sepsis: 5
Pulmonary
Fibrosis: 1
Days on
Mechanical Ventilation prior to initiation of HFOV:
0-3:
5
4-7:
2
8-14:
5
15-21:
1
>21: 2
Time
on FIO2 > .60
<
1 day: 10 (average time 8.6 hours)
1-3
days: 1
4-7
days: 3
8-14
days 1
15-21
days: 0
Time on HFOV
prior to stabilization:
<1
hour: 5 (average 23 min)
2-3
hours 1
4-5
hours 1 (required abdominal decompression)
>5
hours 3
HFOV Failure:5 (one oxygenation failure, 4 ventilation failures)
Ventilation
failure: Most patients had Hx of COPD (n=2)
Oxygenation
failure: Patient was not adequately resuscitated (Base deficit >
10)
Outcomes:
Discharged
from hospital: 4 (one transfer to rehab facility on vent)
Weaned from
HFOV, not CMV 2
Expired on
HFOV 2
Life support
withdrawn 5
Returned to
HFOV 2
Expired on
CMV 3
Observations:
- Stabilization time is inversely proportional to the amount of time on high FIO2 levels, except when surgical intervention is required to increase lung capacity
- Ventilatory failure can be anticipated if a history of COPD exists, though it is not a determining factor for failure. Prior ventilatory failure of HFOV appears to be a predictor of future failure
- Oxygenation failure of HFOV can be predicted by inadequate fluid resuscitation, which can be followed by using the base deficit
- Cuff deflation appears to provide significant advantages to ventilation, and has become an early maneuver to enhance ventilation, rather than a later one
