2006 OPEN FORUM Abstracts
SURVEY ON HIGH FREQUENCY VENTILATION
Brian K. Walsh, RRT-NPS, RPFT
University of Virginia Children's Hospital
Background: The concept of high frequency ventilation (HFV) has been around for over 30 years. However, despite wide routine use for the past 15 years the strategies of HFV vary greatly. This makes consistency of care and protocol development difficult. To help guide educational needs and development of future studies a survey was conducted at the 22nd Conference on High Frequency Ventilation of Infant, Children & Adults.
Method: Seventy five questionnaires were distributed to participants of the conference. The survey was broken into four sections, demographics, high frequency jet (HFJV), high frequency oscillators (HFOV) and adjunct therapy to high frequency ventilation. Each questionnaire was composed of 18 questions that related to management of HFV with 3-5 possible answers in a multiple choice format.
Results: Demographics - Return rate was 43% (32/75). 67% of participants managed 4 or more HFV patients a week. 88% of the group used the SensorMedics product (3100 A and/or B). 12% used both the Bunnell and SensorMedics product. A majority (52%) of initiation and adjustments where determined by the physicians, but accepted guidelines or protocols was a close second at 48%. HFJV - due poor participation in this section we excluded the data. 1.3% or 4 individuals completed questions in this section. HFOV - 53% of the group determine MAP by initially setting 2-4 cmH2O (for neonates) and 4-6 cmH2O (for pediatrics and adults) above conventional ventilation MAP. There was an even split of the group when it came to hertz (Hz) adjustments. 50% of the group would manage the Hz according to disease process while the other ½ of the group would base Hz setting on patient size. However, each group would lower the Hz after maximizing the power. 100% of the healthcare professionals set the inspiratory time at 33% and adjusted initial delta P/power based on chest wiggle (neonates) and/or thigh wiggle (adults), then based on PCO2. HFV Adjunct Therapy - 50% of the group use nitric oxide when there is evidence of pulmonary hypertension while 28% of the group had never used nitric oxide with HFV. 65% of the group would use heliox in airway obstruction. 35% of the groups would use heliox with uncontrollable/uncorrectable air leak syndrome. 58% never give inhaled medications with HFV and none surveyed administers inhaled medications routinely. 88% thought that inhaled medication where not effective during HFV.
Conclusion: Despite criticisms about the lack of consistence in the management of the HFV patient, there are some adjustment and targets that we can agree. We should build on those agreements and develop more guidelines/protocols, research and education to provide the best patient outcomes for this beneficial mode of ventilation.