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INTRODUCTION
Case Report
Case Report CONCLUSIONS
CLINICAL IMPLICATIONS
REFERENCES
Rescue with High Frequency Oscillatory Ventilation in a 22-Year-Old Female
High frequency oscillatory ventilation (HFOV) is a form
of lung-protective ventilation with limited evidence for
use in the adult population. Despite this lack of data,
HFOV remains a viable option as a rescue therapy for
severe refractory hypoxemia after other modalities of
ventilation have failed.
We report the case of a 22-year-old pregnant female
who initially presented from an outside hospital with
nausea, emesis and fatigue. Her symptoms progressed
to refractory hypotension and hypoxemia secondary to
urosepsis and pulmonary edema. The patient remained
hypoxemic during a trial of non-invasive ventilation
(NIV). She was subsequently intubated and placed on
conventional mechanical ventilation using pressure
regulated volume control (PRVC). The patient
continued to deteriorate leading to cardiopulmonary
arrest. Multiple rounds of epinephrine and CPR were
required before achieving ROSC. The patient was not a
viable candidate for ECMO therapy per CT surgery.
Discussions with the family were prompted by the
attending physician and hospital chaplain surrounding
the grave prognosis of the patient. Post arrest, arterial
blood gas (ABG) values of pH 7.26, PaCO2 44, PaO2 40,
HCO3- 19.7, BE -7.0, SaO2 67.4% were obtained on
PRVC with settings of Vt 350 mL, RR 25
breaths/minute, PEEP 20 cmH2O, FiO2 100%, and I:E
ratio 2:1.
HFOV was initiated as a rescue therapy. Initial HFOV settings were MAP
33 cmH2O, 4 Hz, Power 9, bias flow 25 l/min, I-time 33%, and FiO2
100%. One hour post HFOV initiation, PaO2 51mmHg with SaO2 87.8%.
After 3 hours on the oscillator, ABG revealed pH 7.54, PaCO2 24.7, PaO2
190, HCO3- 20.6, BE -1.1, SaO2 99%. Weaning down to minimal
oscillator settings occurred twenty-two hours post HFOV initiation.
Transition back to conventional mechanical ventilation was successful
after 29 total hours on the oscillator. Subsequently, the patient was
extubated to a nasal cannula, appropriate and following commands.
HFOV is an effective rescue therapy for severely
hypoxemic respiratory failure patients who are failing
conventional ventilation. HFOV can effectively deliver a
substantial mean airway pressure, improve ventilation-
perfusion matching, and increase oxygenation. Patient
selection and clinician expertise remain key variables
impacting HFOV outcomes.
1. Derdak S, Mehta S, Stewart TE, Smith T, Rogers M, Buchman TG,
Carlin B, Lowson S, Granton J: The Multicenter Oscillatory
Ventilation for Acute Respiratory Distress Syndrome Trial (MOAT)
study investigators: high-frequency oscillatory ventilation for acute
respiratory distress syndrome in adults: a randomized, controlled
trial. Am J Respir Crit Care Med. 2002, 166: 801-808.
10.1164/rccm.2108052.
2. Nguyen AP, Schmidt UH, MacIntyre NR. Should High-Frequency
Ventilation in the Adult Be Abandoned?. Respir Care.
2016;61(6):791-800. doi:10.4187/respcare.04584
Herrington, Ramona RRT (1) , Weaver, Chaston RRT (1) , Ford, Leslie MS, RRT (2) , Kumar, Vikas MD (3)
1. Respiratory Care Department, Augusta University Medical Center, Augusta, Georgia
2. Respiratory Therapy Program, Augusta University, Augusta, Georgia
3. Department of Anesthesiology and Perioperative Medicine, Augusta University, Augusta, Georgia
This case provides valuable insight for the use of HFOV
in patients who are failing conventional mechanical
ventilation despite maximal manipulation of the
variables which support oxygenation. In patients who
are ineligible for ECMO therapy, HFOV is a viable rescue
therapy. This case also compliments a multidisciplinary
teamwork approach involved in the critical care of an
antepartum patient.
Pre HFOV Post HFOV
