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.