2012 OPEN FORUM Abstracts
USING HIGH FLOW NASAL CANNULA IN CONJUCTION WITH THE PASSY MUIR VALVE TO WEAN FROM VENTILATOR.
Tera Martin, Maria Madden, Matthew Davis, Peter Saunders, Venessa Peregrim, James Huff, Angela Toney, Kate Dolly, Christoper Kircher, Deborah Stein MD; Respiratory Care,, University of Maryland Medical Center/R Adams Cowley Shock Trauma Center, Baltimore, MD
Introduction: Complete cervical spinal cord injury (C-SCI) patients can require mechanical ventilation for weeks prior to being weaned. A study by Dr. Como in 2005 stated that 100% of C5 and above C-SCI patients will require tracheostomy and 71% of all C5 SCI patients required mechanical ventilation at discharge. We hypothesize that using a high flow nasal cannula (HFNC) in conjunction with a speaking valve, could provide a bridge to aerosol trach collar. Though HFNC, in theory, is a low pressure interface with the patient, we further theorize that the actual pressure being delivered to patients with a tracheostomy tube and speaking valve may be higher than normal. To help quantify the amount of pressure, we simulated the scenario by placing a pressure manometer inline on the tracheostomy tube and speaking valve with a HFNC device at forty liters per minute. The pressure was measured between 2-4 cm H2O. Case Summary: A 69-year-old male that suffered a complete spinal cord injury at C5 resulting from a fall, was transferred to our facility after failure to wean at another medical center. It had been reported that when the patient was ready to be weaned from the mechanical ventilator to aerosol trach collar, the patient did not tolerate independent breathing for more than five minutes each time. The decision was made to try our lab-tested theory on this patient by setting up a HFNC in conjunction with a speaking valve. Subsequently, we were able to see the patient tolerate longer and longer trach collar trials, eventually being ventilator-free for longer than 24 hours. Conclusion: The use of both a speaking valve and HFNC helped liberate our patient from the mechanical ventilator. While this is only a single patient, the outcome was promising. The authors agree that further research is needed.