The Science Journal of the American Association for Respiratory Care

2010 OPEN FORUM Abstracts

A CASE STUDY: USE OF HIGH FLOW NASAL AND VIBRATING MESH NEBULIZER DURING ASTHMA EXACERBATION ON A PREGNANT WOMAN

Pamela J. McDermott, Patricia Dailey, Srikanth Penunetsa; Respiratory Care, Baystate Medical Center, Springfield, MA

Introduction: High flow nasal cannula has successfully been used with patients during asthma exacerbation1,2. In addition, adequate aerosol delivery through high flow cannula (HFNC) with vibrating mesh nebulizer (VM) has been demonsrated3,4. Our goal was to utilize whatever tools necessary to provide adequate oxygenation for the unborn fetus, provide optimal delivery of aerosolized albuterol at minimal doses, decrease the patient’s work of breathing and avert another intubation for the patient. Case Summary: A 43 year old woman in her last trimester of pregnancy admitted for treatment of acute asthma exacerbation. Her history included 4 intubations for asthma exacerbations. She was placed on heliox (80/20) via non-rebreather mask due to increased work of breathing (WOB) and in-line continuous albuterol via jet nebulizer (Misty Finity™). She continued to deteriorate throughout the night with O2 saturations <90%, respiratory rate (RR) 24, breath sounds decreased aerataion with expiratory wheeze and marked use of accessory muscles. She was placed on 50 lpm HFNC (Fisher & Paykel Optiflow ) at 40% and the nebulizer was changed to a VM (Aeroneb Solo) placed on the dry side of the humidifier. Post HFNC her O2 saturations were >= 93%, RR 20 and decreased use of accessory muscles with some incease in aeration. 2.5 mg of albuterol was administered with VM nebulizer. Post treatment she had further increase in aeration with increased aeration. Patient visibly appeared less distress and continued to improve. She gave birth to a health infant and intubation was not required for this admission. Discussion: We were able to accomplish our stated goals for this patient using HFNC and VM technology with this patient. This experience in addition to other similar case scenarios has prompted us to pursue IRB approval for a controlled study looking at the use of HFNC and VM for the treatment of asthma exacerbations. Sponsored Research - None