The Science Journal of the American Association for Respiratory Care

2005 OPEN FORUM Abstracts

A RETROSPECTIVE REVIEW OF HIGH FREQUENCY PERCUSSIVE VENTILATION UTILIZED ON FOUR HUNDRED PATIENTS DURING A FOUR-YEAR TIME PERIOD

Kenneth Miller, MEd, RRT; William Dougherty, M.D.; Larry Mann, RRT; Matthew McCambridge, M.D.; Mark Cippole M.D.; Michael Pasquale, M.D.; Linda Cornman, RRT-NPS; Raymond Smith, RC Lehigh Valley Hospital, Allentown, PA 18105-1556

Introduction: Mechanical support for patients with acute lung injury (ALI) is directed at providing adequate gas exchange while minimizing ventilator induced trauma. Current literature supports the utilization of low tidal volume delivery while maintaining an alveolar distending pressure< 30cmH20. Various technological and pharmacological innovations have been instituted, resulting in mixed clinical outcomes. Included in this group has been the administration of Nitric Oxide, Perflubron, EMCO, and High Frequency Percussive Ventilation (HFPV).

High Frequency Percussive Ventilation is delivered via the Volumetric Diffusive Respirator (VDR). The VDR is the brainchild of Dr. Forest Bird. It is classified as a time-cycled, pressure limited, high flow interrupter, with biphasic oscillatory function. The tidal volume delivery is a product of the peak inspiratory pressure setting, inspiratory time, and oscillatory sub-tidal volumes. Tidal volume delivery is also influenced by the patient's lung compliance and airway resistance. Since tidal volume cannot be measured directly via the VDR, an end-tidal CO2 monitor is employed and chest expansion is assessed to insure adequate volume delivery.

Historically, the VDR has been utilized in Burn Centers to ventilate patients with large surface area burns or patients with thermal airway burns. Recently, it has been used in the ventilator management of patients with refractory elevated inter-cerebral pressure (ICP) associated with acute lung injury. It has demonstrated isolated positive clinical outcomes in this patient population.

Results: Our institution has employed HFPV on various patient populations including traumatic head injury with increased ICP, ALI, airway obstruction, chest trauma, inhalation injury and patients with large surface area burns.

Listed below are the results of HFPV utilization over a four year period at our institution:

Total ICU Burn CHI Rescue
400 156(39%) 244(61%) 24(6%) 75(18%)
Mortality 36(23%) 42(17%) 6(25%) 44(68%)*
Survival 120(77%) 202(83%) 18(75%) 32(32%)
Range of duration 1-14 days 1-84 days 2-10 days 1-10days

*22 patients were selectively withdrawn from mechanically ventilation

Conclusion: Based on our clinical experiences, HFPV is a ventilatory strategy that can provide optimal gas exchange in selected patient populations and can be utilized as a rescue therapy when conventional ventilatory strategies fail. More research and clinical trails need to be conducted to properly determine the role of HFPV as a mainstream ventilatory strategy.

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