The Science Journal of the American Association for Respiratory Care

2005 OPEN FORUM Abstracts

HIGH FREQUENCY OSCILLATORY VENTILATION IN RHEUMATOID VASCULITIS. A CASE REPORT:



Mark E. ­Harris RCP,RRT,NPS. Thomas Serrano BS,RRT,RCP,AE-C. Larry Alpert RCP, RRT. Judi Palumbo RCP,RRT. Mukesh P Shah MD. David Harris MD PRESBYTERIAN INTERCOMMUNITY HOSPITAL WHITTIER CA.

This case report involves a 63 yr old female with rheumatoid vasculitis and pulmonary hypertension which progressed to gross hemorrhaging into the lung and airspace. She presented to the ICU with severe tachypnea hemoptysis, and profound hypoxemia. Sp02 was 63% on 100% oxygen via non-rebreather mask. After sedation and paralysis emergent tracheal intubation was performed and the patient was placed on full ventilatory support. Initial arterial blood gas analysis post tracheal intubation PO2 38 PCO2 85, Ph 7.10 on 100% oxygen, ventilation and PEEP levels were increased without success. Arterial blood gases continued to deteriorate despite maximal support, PO2 36 PCO2 98 Ph 7.06. Due to continuing intractable hypoxemia and hypercarbia rescue treatment with High Frequency Oscillatory Ventilation. (HFOV), was initiated using the Sensormedics 3100A high frequency oscillator at the second hour post intubation. Initial settings on HFOV Amplitude 55, frequency 5 Hz, MAP 25 cmH2O, T(insp) .33 seconds. Frequency was decreased to 3 Hz, amplitude increased to 75 cmH2O, T(insp) 0.5 seconds and cuff leak instituted due to increasing transcutaneous PCO2. Initial blood gas analysis post initiation of HFOV PO2 50 PCO2 60, Ph 7.25 SpO2 83% on 100% oxygen. FIO2 remained at 100% and P02 continued in the 45 mmHg range. MAP was increased in 2 cmH2O increments to 38 cmH2O over the next 4 hours, and after 12h of HFOV the patient was placed in prone position for 20hr/day. On day three FIO2 was .70 with P02's in the mid 60's, PC02 45, Ph 7.34. On day five when MAP was weaned to 22 cmH2O, amplitude 45 cmH2O on 40% oxygen the patient was moved to conventional ventilation frequency 20 /min, Vt 450cc, and FIO2 .40 and paralytics were subsequently removed after a stabilization period of approx 2 hrs. Arterial blood gases on above settings were PO2 72, Ph and PCO2 normal.

CONCLUSION:
It is our belief that utilization of HFOV played a key role in the management of this acute event when conventional means had failed. HFOV proved to be safe and efficacious in the treatment of this patient's disease process.

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