The Science Journal of the American Association for Respiratory Care

2009 OPEN FORUM Abstracts

CONCOMITANT USE OF CONTINUOUS NEBULIZED BRONCHODILATORS AND HEATED HIGH FLOW NASAL CANULA IN ACUTE RESPIRATORY DISTRESS IN A CHILD SIGNIFICANTLY DECREASES WORK OF BREATHING

Greg Jones1, Ariel Berlinski2; 1RCS, Arkansas Childrens Hospital, Little Rock, AR; 2Pediatrics, University of Arkansas for Medical Sciences, Little Rock, AR

Introduction: Pediatric patients with acute respiratory distress and high oxygen demands might also require continuos bronchodilator therapy (CBT). This case study shows that the use of heated high flow nasal canula (HHFNC) concomitantly with CBT could be an effective therapy for those patients. Case Summary: A six-year old female presented to the ER of an outside hospital with a chief complaint of respiratory distress and history of wheezing. The patient was noted to be tachypneic and hypoxemic [RR = 48 and O2 saturation (O2SAT) = 86% on room air]. Multiple nebulized albuterol treatments were given with slight improvement in work of breathing. Due to worsening hypoxemia the patient was placed on a 100% non-rebreather mask and transported to ACH for further care. Upon arrival, the patient was admitted to the PICU (RR = 67 bpm, HR = 129 bpm and O2SAT = 90% on 100% FIO2). Expiratory wheezes and coarse breath sounds were present and patient complaint of chest tightness. Accessory muscle use was noted. Chest radiography revealed right lower lobe pneumonia. The patient was placed on CBT (albuterol 1 mg/kg/hr via HOPE nebulizer at 10 lpm) in-line with a HHFNC (Fisher Paykel) with a FiO2 of 100% and a flow of 15 lpm, for a total flow of 25 lpm. The additional flow was added via T-piece and connected to the HHFNC before the humidifier. She was also started on IV steroids and antibiotics. Within the first hour, the FiO2 was weaned to 60% with O2SAT 94%, RR = 60 and HR = 170. At the 8th her vitals were O2SAT 99% on FiO2 60%, RR = 40 and HR = 156. Her breath sounds were coarse and expiratory wheezes were present. Patient was able to verbally communicate to mother and caregivers. Discussion: Use of a heated high flow nasal canula, along with continuous bronchodilator therapy in a child in respiratory distress and hypoxemia resulted in clinical improvement as evidenced by physical exam, and patient report. The use of these 2 devices together kept the patient’s face “mask free” decreasing some of the fear that pediatric patients experience in the PICU and allowed a better communication with the patient as well. Sponsored Research - None

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