2010 OPEN FORUM Abstracts
DELIVERY OF INHALED ANESTHETIC IN THE INTENSIVE CARE SETTING USING AN ICU VENTILATOR AND STAND ALONE VAPORIZER.
Douglas A. Campbell, Faith A. Carrier, Jeremy S. Bainbridge, Emily L. Zyla; Respiratory Care Department, Spectrum Health Hospitals, Grand Rapids, MI
Introduction: Administering inhaled Isoflurane to the status asthmaticus patient in an ICU is difficult because an anesthesia ventilator is suboptimal for ventilating this patient population. The limitations include but are not limited to: inability to deliver continuous inhaled bronchodilators, delivery of helium-oxygen mixtures, and the fact that our respiratory therapists are not trained to operate the anesthesia ventilator. The aforementioned has resulted in deviations from optimal lung protective ventilation. To attempt to improve ventilation choices we wondered can you safely deliver a therapeutic dose of Isoflurane through a stand-alone vaporizer and an ICU quality ventilator. Methods: We evaluated the Drager 19.1 series Isoflurane vaporizer, obtained a Datex Ohmeda 5250 RGM anesthesia monitor, developed a gas savaging system, and a Servo 300 ventilator capable of volume and pressure ventilation. The vaporizer was placed in line with the inspiratory limb. Inspiratory and expiratory Isoflurane concentrations were measured at the wye adapter as well as the amount of anesthetic used. Our targeted Isoflurane concentration is 1% of total gas volume delivered to the patient. Results: In a laboratory setting, we were able to achieve the targeted Isoflurane concentration at the ventilator circuit wye adapter. Both volume (100 600 mL) and pressure (PIP 16 36 cwp with a constant PEEP of 8 cwp) modes of ventilation were evaluated. Ventilation with these parameters would be used in the clinical setting for adult or pediatric ventilation at our institution. Conclusion: Isoflurane has been shown to benefit status asthmaticus patients resistant to other therapy. The problem is means of delivery, anesthesia time at the bedside and the ability to adequately ventilate the patient. Isoflurane can be safely delivered utilizing an ICU quality ventilator and a standalone vaporizer and should be considered a viable option. Sponsored Research - None