2011 OPEN FORUM Abstracts
TRANSITION FROM HIGH FREQUENCY OSCILLATORY VENTILATION TO BIVENT MODE OF VENTILATION TO FACILITATE INTRA-HOSPITAL PATIENT TRANSPORT: A CASE REPORT.
Ryan Stecks1, Randy Willis1, Gary R. Lowe1, Mark Heulitt1,2; 1Respiratory Care, Arkansas Children's Hospital, Little Rock, AR; 2Dept. of Pediatrics, Critical Care Medicine Section, University of Arkansas for Medical Sciences, Little Rock, AR
Introduction: Patient transports within the hospital are frequent occurrences to provide diagnostic testing and specialized procedures. This case illustrates a positive outcome of a patient who was supported on high frequency oscillatory ventilation (HFOV) and was transitioned to the Servo-i TM in the BiVent mode to facilitate transport to obtain a computerized tomography scan (CT) after failing transition to conventional ventilator support. Case Summary: A 14 year old male with Hodgkin's lymphoma was being supported with HFOV. For reason of prognosis, the patient required a diagnostic CT necessitating a high-risk transport. It was not deemed possible to transfer the patient on HFOV and he failed an attempt to transition to PRVC secondary to high PIPs (58-60 cmH2O). Discussion ensued regarding the transition of the patient to the BiVent mode. During this transition blood gases and pulse oximetry were closely monitored to ensure that ventilatory deterioration did not occur. The patient's ventilatory status remained stable over the next 7 hours to allow time for transition and to account for CT availability. The only change that occurred during the transport to CT was an increase in the FIO2 to 1.0, otherwise the patient tolerated the transport without incident, and the diagnostic testing was accomplished. Discussion: Medical personnel are frequently faced with the decision of transporting patients requiring intense ventilatory support. This decision requires balancing the risk of transporting the patient versus the potential information obtained. In this case study, a detailed process was undertaken to ensure that the patient did not deteriorate after being transitioned to an alternative mode of ventilation. This exposed the patient to minimal risk and facilitated the transport for important diagnostic information. We found that ventilation in the BiVent mode allowed for this patient to be transitioned from HFOV for a short time period to accommodate transport for diagnostic testing without the risk of high ventilatory pressures seen with conventional ventilation.
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Serial blood gases obtained pre- and post-transport.