2010 OPEN FORUM Abstracts
INFLUENZA PEDIATRIC PATIENT WITH ACUTE LUNG INJURY WEANED WITH AIRWAY PRESSURE RELEASE VENTILATION: A CASE STUDY.
Tammy Schultz, Grant D. Wilson; Respiratory Care, Mayo Clinic, Rochester, MN
Introduction: Providing appropriate ventilation to lung injured patients can become complicated. In this case study a variety of ventilation modes are attempted but patient was unable to be weaned until APRV was initiated and paralytic discontinued. Case Study: A 5 year old pediatric patient admitted to the emergency department for dyspnea, lethargic and fever for the past 6 days. Chest x-ray (CXR) showed hyperinflation, perihilar infiltrates and small patchy bilateral infiltrates at the costophrenic angles. Influenza swab completed and results were positive. Arterial Blood Gas (ABG) showed pH was 7.13, PaO2 73, PaCO2 85, Base of -1 mm0l/L, and HCO3 11. Patient endotracheally intubated and remained mechanically supported for 16 days. Case Description: Patient was initially placed on Volume Controlled Intermittent Mandatory Ventilation (VC-IMV). One day later Pressure Control Intermittent Mandatory Ventilation (PC-IMV) was initiated. After 2 ½ days of increasing PCV-IMV settings ending with PC-IMV 34 cmH20, rate of 38/min and PEEP of 14 cmH20, ABGs showed pH 7.27, PaC02 70, PaO2 82 and CXR showed complete whiteout of right lung. The Sensormedics pediatric 3100A High Frequency Oscillator (HFO) started but unable to provide enough flow, therefore the Sensormedics adult 3100B HFO was initiated and continued throughout the next 11 days with no progress in weaning. The decision was made to initiate APRV on the Drager Evita XL and stop paralytic therapy. See Table 1 APRV settings weaned by decreasing P High over the next 3 days demonstrating improvement in ABGs and patients CXRs. Patient was then placed on VC-IMV per physician preference and extubated 12 hours later. Conclusion: Patient was intubated for 16 days due to severe respiratory distress secondary to H1N1. Following unsuccessful modes of ventilation and the need to discontinue paralytic therapy, APRV proved to provide effective ventilation and oxygenation while allowing the patient to breathe spontaneously, maintain lung recruitment and weaning of sedation for a successful extubation. Sponsored Research - None