The Science Journal of the American Association for Respiratory Care

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Life support withdrawn 5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:

  1. Stabilization time is inversely proportional to the amount of time on high FIO2 levels, except when surgical intervention is required to increase lung capacity
  2. 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
  3. Oxygenation failure of HFOV can be predicted by inadequate fluid resuscitation, which can be followed by using the base deficit
  4. Cuff deflation appears to provide significant advantages to ventilation, and has become an early maneuver to enhance ventilation, rather than a later one
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