2011 OPEN FORUM Abstracts
USE OF NEURALLY ADJUSTED VENTILATORY ASSIST TECHNOLOGY TO FACILITATE SUCCESSFUL TRANSITION TO A HOME CARE VENTILATOR IN AN INFANT WITH CHRONIC LUNG DISEASE OF PREMATURITY.
Randy Willis1, Dana Young1, Gary R. Lowe1, Ariel Berlinski1,2; 1Respiratory Care, Arkansas Children's Hospital, Little Rock, AR; 2Dept. of Pediatrics, Pulmonary Medicine Section, University of Arkansas for Medical Sciences, Little Rock, AR
Introduction: Infants with chronic lung disease (CLD) requiring chronic mechanical ventilation present challenges to the medical team as they attempt to prepare the patient for homecare. Transition from a hospital type to a home type ventilator is a crucial step. We report on use of Neurally Adjusted Ventilatory Assist (NAVA) technology to aid successful transitioning to a homecare ventilator in an infant with CLD of prematurity. Case Summary: The patient is an 11 month old African American male, former 25-week preterm (birth weight 805 gm). He was born at another institution where he received surfactant therapy x1, and was placed on mechanical ventilation. He failed extubation 5 times and was successfully extubated on the 6th attempt at 2 months of age. The infant continued to have frequent episodes of tachypnea with desaturations and significant retractions. He developed CLD of prematurity and was transferred to our Hospital at 3.9 months of age for evaluation. The patient was supported with heated high flow nasal cannula (HHFNC) (3 LPM/1.0 FIO2). The infant was subsequently diagnosed with pulmonary hypertension and was started on sildenafil and inhaled nitric oxide at 10 ppm via HHFNC. He was reintubated at 5 1/2 months of age due to hypercarbia (PaCO2 62-63 mmHg) and increased work of breathing (WOB). The patient was tracheotomized at age 6.7 months and was transferred to our long term care unit 2 months later. The plan of care was to transition from the Servo-iTM to a LTV 1200TM home ventilator for discharge. Once stable ventilator settings were reached the patient failed 3 attempts to transition to the LTV due to hypercarbia and increased WOB. The longest time on the LTV was 28 hours. At 11 months of age, a NAVA catheter was placed and used to optimize ventilator settings while on the Servo-i. The patient was then transitioned to an LTV and the NAVA catheter was kept in place for 4 days. Ventilator adjustments were made focusing on the Edi as an indicator of WOB and included increasing pressure support from 10 to 13 cm H2O and adjusting the Rise Time Profile from 4 to 5, thereby decreasing the inspiratory rise time. The transition was successful and the patient was discharged home one month later. Discussion: Medical teams are challenged with patients with CLD who are difficult to transition to a home ventilator. NAVA allowed for the collection of objective data correlating to the WOB, and allowed for "real-time" ventilator adjustments.
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