The Science Journal of the American Association for Respiratory Care

2010 OPEN FORUM Abstracts

PROCEDURAL VENTILATION BY RT MANAGED HIGH FREQUENCY OSCILLATION VENTILATION (HFOV) DURING CARDIAC TISSUE ABLATIONS IN THE EP LAB IMPROVES CATHETER STABILITY AND DECREASES PROCEDURE TIMES

John T. Murphy1, John Moore2; 1Respiratory Therapy, St Francis Hospital, Indianapolis, IN; 2Cardiovascular Care Center, St. Francis Hospital, Indianapolis, IN

Background Electrophysiologists (EP) use radiofrequency catheter ablation to treat tachyarrhythmias. Spontaneous breathing (SB) performance or conventional ventilation (CV) can produce excessive cardiac motion via cardiac-thoracic coupling, which contributes to catheter instability. Excess cardiac motion increases procedural difficulty and time, and can result in damage to adjacent tissue. EP physicians consulted respiratory therapy (RT) for high frequency oscillatory ventilation (HFOV) methods seeking cardiac motion reduction and improved catheter stability. Methods RT proposed HFOV to limit chest motion to a wiggle, eliminating cyclic inflation and deep diaphragmatic excursion. Each patient was sterilely draped under fluoroscopy throughout the procedure and Anesthesiology placed arterial lines for ABG analysis. RT connected to HFOV from CV after recruitment maneuver of 30 cwp for 30 seconds. FiO2 was set to 0.60, Mean Paw was set to 5 cwp above Mean Paw on CV, Rate was 9Hz (540 bpm), bias flow was 30 lpm, power set at 6 was adjusted upward watching for chest wiggle from the clavicle to upper thigh for optimal chest wiggle factor (CWF). ABG interval was 45-60 minutes, trending TcPCO2 used. Permissive hypercapnea strategy allowed PCO2 levels of 40-70, to maintain pH > 7.20. Standard CareFusion 3100B adjustments were planned with rate ≥ 8 Hz to reduce cardiac motion. Results Chest motion reduction from HFOV wiggle and other method adjustments improved catheter stability compared to SB and CV method cases. HFOV minutes decreased to an average of 175,compared to some cases where SB and CV methods were used. Initial Mean Paw was 18.8 cwp and the average PaCO2 was 44 mmHg. Patients receiving ablations for atrial fibrillation and AV node reentry tachycardias (AVNRT) tolerated HFOV satisfactorily. This method permitted quick extubation post HFOV averaging 18 minutes. Conclusion Two patients who had failed AVNRT ablation with SB had success with HFOV. Catheter stability is improved by limiting cardiac motion. Our facility has adopted respiratory therapy managed HFOV as the standard method of ventilation for atrial fibrillation ablations and the preferred method of mechanical ventilation for ablations in the EP lab.Decreased procedure times occur using HFOV over some SB and CV method cases. Sponsored Research - None

Table 1- Patient data, Ablation type, HFOV minutes, mean Paw start, mean Paw range, High PaCO2, Avg. PaCO2, minutes to extubate after HFOV