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.