2007 OPEN FORUM Abstracts
EARLY HIGH FREQUENCY OSCILLATORY VENTILATION INTERVENTION IN THE ADULT POST SURGICAL ACUTE LUNG INJURY PATIENT: A CASE STUDY
R. D. Herrington1, L. C. Ford1
High Frequency Oscillatory Ventilation (HFOV) has been used successfully in the pediatric and neonatal population. The application of HFOV has been reported primarily as a rescue ventilatory mode in adults and was only initiated when conventional ventilation had failed. This case study involves a 26 year old female admitted emergently for a left ruptured ectopic pregnancy. She was rushed to the operating room (OR) where a left salpinectomy was performed. The patient experienced significant blood loss and received numerous blood products and fluids. After extubation in the OR, oxygen saturation could not be maintained above 70%. Arterial blood gas (ABG) results were PH 7.31/ CO2 40/ PaO2 47. The patient was reintubated and transferred to the intensive care unit (ICU). Admitting diagnosis was transfusion related Acute Lung Injury (ALI) vs. volume overload vs. pneumonia. The patient was initiated on conventional ventilation and the ARDS net protocol was instituted. Plateau pressures increased from 28 cmH2O to 42 cm H2O within 5 hours. Ventilator settings were incrementally adjusted to PEEP 18 cm H2O and I:E 2:1. There was little improvement in the patients oxygenation status; therefore fifteen hours after admission the patient was placed on the HFOV. Initial HFOV settings were Paw 35 cmH2O, frequency 7 Hz, amplitude 52, and I-time 33%, FIO2 100%. ABG results one hour post HFOV revealed PH 7.23/ CO2 56.8/ PO2 285. CXR two hours post HFOV showed improved aeration throughout both lung fields. The patient was weaned over the next 49 hours before transition back to conventional ventilation. The patient was subsequently weaned and extubated. After continued improvement, the patient was transferred to the floor and later discharged home. Pulmonary function test (PFT) were performed eight months after discharge and revealed normal lung function. This case study demonstrates that the HFOV was successful in fully recruiting the lungs after reaching maximum lung protective settings on conventional ventilation.