Transcript HFOV Adult Case Study Presentation

HFOV – Adult Case Study
HFOV Case Study - Admission
• 46 yo unrestrained female MVA
• Fractures
– Rt radial, ulna, fibula
– Lt ankle
• RML contusion
• CT head and c-spine negative
• Pt c/o left chest pain and sedated with
morphine and diprivan
• VSS
Admission
HFOV Case Study
• Pt transported to OR for fx repair – VSS
• 24 hours later pt developed respiratory
distress
• CXR revealed diffuse patchy infiltrates
ABG’s
Date
Time
FiO2
Mode
Rate
Volume
MAP
AMP
PIP
PEEP
pH
PaCO2
PaO2
HCO3SaO2
TcCO2
4/17
NRB
7.38
36
68
21
92
ABG’s
Date
Time
FiO2
Mode
Rate
Volume
MAP
AMP
PIP
PEEP
pH
PaCO2
PaO2
HCO3SaO2
TcCO2
4/17
4/19
0233
NRB
NRB
7.38
36
68
7.38
38
49
21
92
22
82
HFOV Case Study
• Pt placed on 1.0 mask CPAP +10
• Pt increasingly agitated,  SOB, use of
accessory muscles
• Pt subsequently intubated
– 1.0/AC/650/14 (no PEEP)
– SaO2 78%
• Pt sedated and paralyzed
• PEEP  10 cmH2O
ABG’s
Date
Time
FiO2
Mode
Rate
Volume
MAP
AMP
PIP
PEEP
pH
PaCO2
PaO2
HCO3SaO2
TcCO2
4/17
4/19
0233
NRB
NRB
4/19
1000
1.0
A/C
14
650
7.38
36
68
7.38
38
49
10
7.27
44
80
21
92
22
82
20
93
ABG’s
Date
Time
FiO2
Mode
Rate
Volume
MAP
AMP
PIP
PEEP
pH
PaCO2
PaO2
HCO3SaO2
TcCO2
4/17
4/19
0233
NRB
NRB
4/19
1000
1.0
A/C
14
650
4/21
1100
1.0
A/C
18
650
8
7.43
33
101
22
97
7.38
36
68
7.38
38
49
10
7.27
44
80
21
92
22
82
20
93
HFOV Case Study
• Although ABG’s improved, pt became
increasingly agitated
– RR  30’s
– High pressure limit
– BP, HR 
– SaO2  40’s
Pre HFOV – 4/21 – 11:00 hrs
HFOV Case Study
• Pt transitioned to HFOV
– MAP 28, Hz 5, Amp 70, I time 33%, FiO2 1.0
– Pt paralyzed and sedated, TcCO2 76-78
– ABG 7.13/87/159
– Amp  86, dopamine and sedation weaned
– ABG 7.21/65/116
– FiO2  .70, Amp  98
– ABG 7.33/50/101
ABG’s
Date
Time
FiO2
Mode
Rate
Volume
MAP
AMP
PIP
PEEP
pH
PaCO2
PaO2
HCO3SaO2
TcCO2
4/17
4/19
0233
NRB
NRB
4/19
1000
1.0
A/C
14
650
4/21
1100
1.0
A/C
18
650
4/21
1200
1.0
HFOV
5Hz
28
70
7.38
36
68
7.38
38
49
10
7.27
44
80
21
92
22
82
20
93
8
7.43
33
101
22
97
7.13
87
159
28
98
77
ABG’s
Date
Time
FiO2
Mode
Rate
Volume
MAP
AMP
PIP
PEEP
pH
PaCO2
PaO2
HCO3SaO2
TcCO2
4/17
4/19
0233
NRB
NRB
4/19
1000
1.0
A/C
14
650
7.38
36
68
7.38
38
49
10
7.27
44
80
21
92
22
82
20
93
4/21
1100
1.0
A/C
18
650
8
7.43
33
101
22
97
4/21
1200
1.0
HFOV
5Hz
4/21
1430
0.7
HFOV
5Hz
28
70
28
86
7.13
87
159
7.23
65
108
28
98
77
27
96
ABG’s
Date
Time
FiO2
Mode
Rate
Volume
MAP
AMP
PIP
PEEP
pH
PaCO2
PaO2
HCO3SaO2
TcCO2
4/17
4/19
0233
NRB
NRB
4/19
1000
1.0
A/C
14
650
7.38
36
68
7.38
38
49
10
7.27
44
80
21
92
22
82
20
93
4/21
1100
1.0
A/C
18
650
8
7.43
33
101
22
97
4/21
1200
1.0
HFOV
5Hz
4/21
1430
0.7
HFOV
5Hz
4/21
1935
0.5
HFOV
5Hz
28
70
28
86
28
98
7.13
87
159
7.23
65
108
7.33
50
101
28
98
77
27
96
26
96
ABG’s
Date
Time
FiO2
Mode
Rate
Volume
MAP
AMP
PIP
PEEP
pH
PaCO2
PaO2
HCO3SaO2
TcCO2
4/17
NRB
4/19
0233
NRB
4/19
1000
1.0
A/C
14
650
7.38
36
68
7.38
38
49
10
7.27
44
80
21
92
22
82
20
93
4/21
1100
1.0
A/C
18
650
8
7.43
33
101
22
97
4/21
1200
1.0
HFOV
5Hz
4/21
1430
0.7
HFOV
5Hz
4/21
1935
0.5
HFOV
5Hz
4/22
0.4
HFOV
5Hz
28
70
28
86
28
98
25
98
7.13
87
159
7.23
65
108
7.33
50
101
7.35
59
91
28
98
77
27
96
26
96
32
96
HFOV – 4/22 – 04:39 hrs
ABG’s
Date
Time
FiO2
Mode
Rate
Volume
MAP
AMP
PIP
PEEP
pH
PaCO2
PaO2
4/19
0233
HCO3SaO2
TcCO2
NRB
4/19
1000
1.0
A/C
14
650
4/21
1100
1.0
A/C
18
650
7.38
38
49
10
7.27
44
80
8
7.43
33
101
22
82
20
93
22
97
4/21
1200
1.0
HFOV
5Hz
4/21
1430
0.7
HFOV
5Hz
4/21
1935
0.5
HFOV
5Hz
4/22
4/23
0.4
HFOV
5Hz
0.4
HFOV
4Hz
28
70
28
86
28
98
25
98
22
98
7.13
87
159
7.23
65
108
7.33
50
101
7.35
59
91
7.4
45
82
28
98
77
27
96
26
96
32
96
27
95
HFOV – 4/23 – 10:26 hrs
Transition to CMV
• PCV
– PIP = 30cmH2O
– Vt = 680 (wt 75kg)
– FiO2 = .60
– PEEP = 5cmH2O
• ABG
– 7.47/44/62
• PCV
– PIP  20cmH2O, PEEP  8cmH2O
ABG’s
Date
Time
FiO2
Mode
Rate
Volume
MAP
AMP
PIP
PEEP
pH
PaCO2
PaO2
4/19
1000
1.0
A/C
14
650
4/21
1100
1.0
A/C
18
650
10
7.27
44
80
8
7.43
33
101
HCO3SaO2
TcCO2
20
93
22
97
4/21
1200
1.0
HFOV
5Hz
4/21
1430
0.7
HFOV
5Hz
4/21
1935
0.5
HFOV
5Hz
4/22
4/23
4/24
0.4
HFOV
5Hz
0.4
HFOV
4Hz
0.6
PCV
18
680
28
70
28
86
28
98
25
98
22
98
7.13
87
159
7.23
65
108
7.33
50
101
7.35
59
91
7.4
45
82
30
5
7.47
44
62
28
98
77
27
96
26
96
32
96
27
95
32
91
PCV – 4/24 – 07:58 hrs
ABG’s
Date
Time
FiO2
Mode
Rate
Volume
MAP
AMP
PIP
PEEP
pH
PaCO2
PaO2
4/21
1100
1.0
A/C
18
650
HCO3SaO2
TcCO2
22
97
8
7.43
33
101
4/21
1200
1.0
HFOV
5Hz
4/21
1430
0.7
HFOV
5Hz
4/21
1935
0.5
HFOV
5Hz
4/22
4/23
4/24
4/24
0.4
HFOV
5Hz
0.4
HFOV
4Hz
0.6
PCV
18
680
0.5
PCV
12
28
70
28
86
28
98
25
98
22
98
20
8
7.46
45
163
31
99
7.13
87
159
7.23
65
108
7.33
50
101
7.35
59
91
7.4
45
82
30
5
7.47
44
62
28
98
77
27
96
26
96
32
96
27
95
32
91
ABG’s
Date
4/21
Time
1200
FiO2
1.0
Mode
HFOV
Rate
5Hz
Volume
MAP
28
AMP
70
PIP
PEEP
pH
7.13
PaCO2
87
PaO2
159
HCO3SaO2
TcCO2
28
98
77
4/21
1430
0.7
HFOV
5Hz
4/21
1935
0.5
HFOV
5Hz
4/22
4/23
4/24
4/24
4/29
0.4
HFOV
5Hz
0.4
HFOV
4Hz
0.6
PCV
18
680
0.5
PCV
12
0.4
PSV
28
86
28
98
25
98
22
98
20
8
7.46
45
163
5
5
7.49
33
150
31
99
24
99
7.23
65
108
7.33
50
101
7.35
59
91
7.4
45
82
30
5
7.47
44
62
27
96
26
96
32
96
27
95
32
91
HFOV Case Study
• Pt extubated on 4/29 and placed on 40%
HHM, bronchodilator therapy and
incentive spirometry
• Pt discharged to rehab facility on 5/2