The Science Journal of the American Association for Respiratory Care

2011 OPEN FORUM Abstracts

APPLICATION, MONITORING AND IMPLEMENTATION.

Mohammad F. Siddiqui1, Ryan K. Adkins1, Robert A. Bopp1, Robert L. Chatburn2, Eduardo Mireles-Cabodevila1; 1Division of Pulmonary and Critical Care Medicine, UAMS, Little Rock, AR; 2Respiratory Institute, Cleveland Clinic, Cleveland, AR

Introduction: The popularity of High Frequency Oscillatory Ventilation (HFOV) increased after the influenza pandemic. Many hospitals acquired and implemented its use. However, the use of HFOV is far less frequent than conventional mechanical ventilation. This can result in errors on its application due to lack of training and practice. Further, there is practice variation in how to titrate HFOV and achieve the goals of ventilation and/or oxygenation. We created an algorithm to standardize the application of HFOV in an academic institution that started a HFOV program. We present the result of the first cases. Methods: A protocol was developed based on literature, other centers practice/ protocols and the authors experience. The protocol gives rules and goals from which two algorithms were constructed for management of ventilation and oxygenation. The algorithm and the protocol were placed at the bedside. The respiratory therapist (RT) had been trained on the use of the device, some had experience with pediatric HFOV, but had never applied it in adult population. At shift change, the RT, nurse, resident and the critical care fellow (all practically neophytes in adult HFOV) had a brief bedside training. We obtained the data on gas exchange, ventilator settings and changes on the initial patients placed on HFOV with this protocol. We evaluated time on HFOV, time at ventilation goals and protocol compliance. Results: Table 1 illustrates the time on ventilation and protocol compliance as percent of time. Compliance was achieved in majority of the time on HFOV. Most of the protocol non-compliance occurred during the initial hours of shift change with a new RT and during night shift. The non-compliance, however did not necessarily occur in the early period after the initiation of HFOV, and did not occur more so with either the ventilation algorithm or the oxygenation algorithm. The respiratory therapists reported ease of use of HFOV with an algorithm-based protocol approach. Conclusion: The two cases illustrate the convenience of using an algorithm-based protocol in a neophyte population to achieve goals set by a HFOV protocol. The standardized algorithmic approach allows recognition of opportunities to improve and sources of error and non-compliance.
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@CAPTION_P:Table 1. HFOV Algorithm compliance