The Science Journal of the American Association for Respiratory Care

2008 OPEN FORUM Abstracts

LATE APPLICATION AND PROLONGED USE OF HIGH FREQUENCY OSCILLATION IN A SEPTIC PATIENT WITH ARDS

Michael Bocci1, Ken Hargett1, Krista Turner1, Jose Rodriguez1, Jeff Wilson1, Jeff Sutton1, Elizabeth Ostrander1, Abraham Ghebremicael1



Introduction: The use of the 3100 B with the adult population has been the topic of much discussion. As in most uses of the 3100 B, High Frequency Oscillation Ventilation (HFOV) is reserved as rescue therapy when conventional mechanical ventilation has failed. In this case, our "triggers" for conversion to HFOV had been met, yet a delay of almost 48 hours had passed before the patient was placed on HFOV. The patient remained on the HFOV for almost seven days - twice as long as the traditional application in adults. The "late" intervention and "extended" length of use manifests this case as unique and of exceptional educational value.

Case Summary: A 48 year old woman was admitted on 4/21 for lithotripsy for nephrolithiasis. She developed severe urosepsis secondary to the intervention. Multisystem organ failure quickly ensued, including ARDS requiring mechanical ventilation. On 4/21, the patient was placed on conventional mechanical ventilation. PEEP was increased to 14 while maintaining FiO2 of 1.0. The patient's status worsened despite conversion to APRV and she met criteria for HFOV. On 4/23, she was placed on HFOV with initial settings of FiO2 of 1.0 and MAP of 37 cm H2O. Oscillator vent checks were routinely performed every three hours. MAP was maintained at an average of 37cm H2O for 75 hours. Physicians were in agreement on the unique care plan. FiO2 was weaned from 1.0 as quickly as able while maintaining initial MAP settings. For the next 12 hours, MAP averaged 32 with FiO2 at 0.5. At MAP of 30, the patient suffered from desaturation. In response, the MAP was increased to 32 and maintained for 36 hours, with temporary increase in FiO2. On 4/28, MAP was manipulated down to 30. Weaning continued for the next 36 hours with end results of MAP of 25 and FiO2 of 0.4. Patient was returned to conventional ventilation at this point. Several respiratory muscle strengthening sessions were conducted, culminating in complete removal of ventilator support and discharge of the patient from the hospital.

Discussion: During the 7 days on the 3100 B, the patient was closely monitored per our HFOV ventilator management protocol. The extended length of stay on the HFOV was critical and the process proved most beneficial for the patient. The unique weaning process was most significant to the successful discharge of the patient from the hospital.