The Science Journal of the American Association for Respiratory Care

2008 OPEN FORUM Abstracts


Jeffery L. Widell1, Joseph W. Hegge1

Background: This case study presents a 44 year old African-American woman admitted through the emergency department with an acute asthma exacerbation.The patient has a 30-pack history of smoking and several past admissions to the hospital for asthma exacerbations, two resulting in intubation. Despite aggressive therapy in the ER, her condition did not improve and ultimately she was admitted for further monitoring and therapy.

Methods: Hours after admission the patient experienced rebound shortness of breath and increasing respiratory distress. She was transferred to the ICU for monitoring and more aggressive therapy. The patient was eventually placed on BiPAP via the Vision with settings of IPAP 15, EPAP 5, FIO2 60%. Several hours after she was placed on the BiPAP her status did not improve. Arterial blood gas sample revealed PH 7.22, Pco2 61, PO2 of 140, SAO2 97%, HCO3 26, on a FIO2 of 60%.The patient was in impending respiratory failure and was close to being intubated. As a last effort to prevent intubation, the patient was placed on non-invasive ventilation with HeliOx via the AVEA Comprehensive Ventilator. The patient was placed on Pressure Support ventilation with settings of 15 Pressure Support and 5 of PEEP. Leak compensation was turned on and alarm limits were adjusted. The HeliOx was run at 60% with an FIO2 of 40%.

Results: An arterial blood gas sample was drawn 90 minutes after the initiation of HeliOx and non-invasive ventilation. The results revealed a PH 7.32, PCO2 46, PO2 179, SAO2 98%. The patient's work of breathing was greatly reduced. The HeliOx was eventually weaned followed by the non-invasive ventilation. She remained in the ICU for several days and was eventually transferred to the floor and ultimately discharged with no further complications.

Conclusion: Prior to the AVEA Ventilator in our facility, there was not an effective and reliable method to deliver HeliOx to a critically ill patient requiring ventilatory assistance. The AVEA Ventilator is effective in patients requiring intubation and HeliOx, but through this case we have been able to see the effectiveness of the AVEA as a non-invasive HeliOx Ventilator. By avoiding intubation, we achieved many favorable outcomes, including increased patient comfort, decreased risk of the patient acquiring ventilator associated pneumonia and reducing the patients' length of stay in the hospital with complications often caused by endotracheal intubation of asthmatics.