The Science Journal of the American Association for Respiratory Care

2012 OPEN FORUM Abstracts

HELIOX DELIVERED VIA HIGH FREQUENCY JET VENTILATOR AUGMENTS CARBON DIOXIDE REMOVAL IN AN EXTREMELY PRETERM INFANT.

Dolia Horton1, David Durand2; 1Respiratory Care Department, ChildrenÂ’s Hospital & Research Center Oakland, Oakland, CA; 2Department of Neonatology, ChildrenÂ’s Hospital & Research Center Oakland, Oakland, CA

Introduction: The Bunnell Life Pulse High Frequency Ventilator (HFJV) has been used for many years to ventilate preterm infants with severe lung disease, including pulmonary interstitial emphysema (PIE). Heliox (HeO2) has been used to enhance CO2 elimination in multiple patient populations, particularly where gas trapping is a significant problem. However, we are unaware of previous reports of combined HFJV and HeO2 to manage preterm infants. We report here the successful use of HeO2 combined with HFJV to augment CO2 elimination in an extremely premature infant with gas trapping. Case Summary: This patient was born at 27 weeks gestation with a birth weight of 825 grams. He had severe respiratory distress syndrome and was treated with three doses of surfactant. He later developed severe bilateral PIE and left tension pneumothorax. He was placed on HFJV to treat the PIE with HFJV settings chosen to minimize gas trapping while providing appropriate ventilation and oxygenation. Despite multiple HFJV adjustments, he continued to show PIE on chest radiograph and hypercarbia on blood gas and correlated transcutaneous monitor (PtcCO2). Due to persistent hypercarbia and PIE, we trialed HeO2 combined with HFJV to improve ventilation. A HeO2 blender was used to accurately titrate the FIO2. The HeO2 mixture was connected to the gas inlet port of the Life Pulse HFJV so that HeO2 was the driving and delivery gas of the ventilator. Within 5 minutes of starting HeO2, PtcCO2 decreased by 20 mm Hg, and we began decreasing HFJV settings. The patient was treated with a total of 11 days of combined HeO2 and HFJV. He had progressive resolution of his PIE, was successfully extubated, and was subsequently discharged home. Discussion: HeO2 may be a useful adjunct to HFJV for enhancing CO2 elimination and allowing decreased levels of PIP for patients with significant lung disease characterized by air-trapping and hypercarbia. The use of HeO2 is limited to patients who can be managed with a relatively low FIO2. Sponsored Research - None