The Science Journal of the American Association for Respiratory Care

2012 OPEN FORUM Abstracts

A NOVEL APPROACH TO INITIATING NEONATAL HIGH FREQUENCY VENTILATION IN TRANSPORT: ESTIMATING AMPLITUDE AND INTERPRETING SETTINGS.

Robert S. Rohde; Flight For Life, Childrens Hospital Colorado, Fort Collins, CO

Background: Emergency medical transport of critically ill newborns has become increasingly complicated due to the widespread use of therapies such as high frequency ventilation (HFV). Successful transition of patients to HFV has been hindered by the inability of transport ventilators to measure amplitude. A desire to target and/or match a specific amplitude and have the ability to communicate that information to receiving physicians at Children’s Hospital Colorado, led to our need for developing a method of estimating HFV settings during transport. Objective: To develop a safe and effective, universal method for estimating amplitude on high frequency transport vents. Method: Benchmark testing was performed using a modified TXP High Frequency Ventilator (TXP; Percussionaire, Corp., Sandpoint, ID). A pressure line was connected from the TXP circuit to a Sensormedics 3100a (HFOV) to provide a digital readout of TXP amplitude. Working pressure (WP), Rate (Hz), and Mean Airway Pressure were constant while two levels of amplitude were measured. The first level was measured with a test lung, representing high compliance. The second level was measured while capped, representing the lowest possible compliance (Max Amp). Both amplitude levels were measured at specified flows. This method was repeated at various WP and Hz. Result: An estimated amplitude (EA) chart was developed and implemented on transport. The two levels of amplitude provided a range for determining what flow to use on initiation. Clinical application was performed using a HFOV to measure amplitude. This allowed us to confirm accuracy of the EA chart while also providing insight into the severity of the newborn’s lung disease. In most cases, the patient’s measured amplitude fell between the test lung value and Max Amp value on the EA chart. It was discovered that the worse the patient’s lung compliance, the closer the measured amplitude would be to the Max Amp value. Once accuracy of the EA chart was confirmed, it allowed the transport team to target amplitude without the benefit of a digital measurement. Conclusion: Creation of an EA chart proved effective for estimating amplitude on transport. EA charts are vent specific and can be replicated for most high frequency transport devices. They provide a safe and accurate tool for matching settings which lessens the inherent risk of de-compensation that often occurs while transitioning critically ill newborns. Sponsored Research - None