The Science Journal of the American Association for Respiratory Care

2008 OPEN FORUM Abstracts

NON-INVASIVE POSITIVE VENTILATION (NIPPV) WITH HELIUM OXYGEN GAS (HELIOX) IN A PATIENT WITH POST EXTUBATION AIRWAY CONSTRICTION. A CASE STUDY. ANDREA BAKA RRT, KIMBERLY BEERS RRT-NPS, RICHARD PIEKUTOWSKI RRT-NPS

Richard Piekutowski1,2



Introduction: NIPPV and Heliox therapies are widely used for respiratory distress from airway obstruction. There is very little data available on their use together. We present this case to illustrate that it can be done safely in an ICU setting.

Methods: To deliver the Heliox we utilize a blender with an 80/20 tank of helium/oxygen attached to the air inlet of the blender. We utilize this mixture to avoid the possibility of introducing the patient to sub ambient conditions and anoxia. We attached the Respironics Vision Bipap to the blender and controlled the FiO2 and helium concentration from the blender. The Vision was set at 100% to insure that there was no room air introduced into the system.

Case Study: The patient is a 40 year-old female with a history of Multiple Sclerosis, epilepsy and tremors who required intubation and mechanical ventilation due to respiratory failure after prolonged seizure activity. She was orally intubated with a 7.0 endotracheal tube and placed on a Drager Evita XL ventilator: SIMV, VT 500ml, f 12, PEEP 5, PSV 10, FiO2 0.30. She was maintained in a phenobarbital coma for five days and monitored with a continuous EEG. She was then weaned from the mechanical ventilator and extubated. Subsequently she developed stridor, had an increased respiratory rate and marked accessory muscle usage. Her respiratory distress was treated with racemic epinephrine (2.25mg of a 5% solution), PO decadron (8mg tablet Q6hrs) via PEG tube and Heliox via a non rebreather mask. The patient continued to have increasing oxygen requirements, respiratory rate 45 and increased stridor. An ABG revealed pH 7.38, PaCO2 47, PaO2 57, HCO3 27.5, BE 1.9. The patient was placed on a Respironics Vision Bipap IPAP14 EPAP 5 FiO2 40% and 60% Helium. Instantly, the patient appeared comfortable with a decreased respiratory rate and less accessory muscle usage. A follow up ABG revealed ABG pH 7.43, PaCO2 39, PaO2 80, HCO3 25.6, BE 1.9. Later that day, the patient was weaned from NIPPV and Heliox to a nasal cannula without any respiratory complications.

Significance of the Case: NIPPV in combination with Heliox can be administered safely in the ICU setting. It appeared to help decrease the patient's work of breathing, improve the blood gas values and avoid intubation.