Miller, Kenneth, MEd, MSRT, RRT-ACCS, NPS, AE-C, FAARC

Pechulis, Rita, MD, FCCP

Traub, Chad, RRT-ACCS

Watson, Dorothea T, DO

Wu, James K.

English

Lehigh Valley Health Network: LVHN Scholarly Works

Lehigh Valley Health NetworkLVHN Scholarly WorksPatient Care Services / NursingThe Utilization of Independent Lung VentilationVia High Frequency Percussive Ventilation(HFPV) During Extracorporeal MembraneOxygenation (ECMO)Kenneth Miller MEd, MSRT, RRT-ACCS, NPS, AE-C, FAARCLehigh Valley Health Network, Kenneth.Miller@lvhn.orgRita Pechulis MD, FCCPLehigh Valley Health Network, Rita_M.Pechulis@lvhn.orgJames K. WuLehigh Valley Health Network, james.wu@lvhn.orgChad Traub RRT-ACCSLehigh Valley Health Network, Chad_J.Traub@lvhn.orgDorothea T. Watson DOLehigh Valley Health Network, Dorothea_T.Watson@lvhn.orgFollow this and additional works at: https://scholarlyworks.lvhn.org/patient-care-services-nursingPart of the Cardiology Commons, Nursing Commons, and the Surgery CommonsThis Poster is brought to you for free and open access by LVHN Scholarly Works. It has been accepted for inclusion in LVHN Scholarly Works by anauthorized administrator. For more information, please contact LibraryServices@lvhn.org.Published In/Presented AtMiller, K., Pechulis, R., Wu, J., Traub,C. & Watson, D. (2014, December, 8). The Utilization of Independent Lung Ventilation Via HighFrequency Percussive Ventilation (HFPV) During Extracorporeal Membrane Oxygenation (ECMO). The poster session presented at theAmerican Association of Respiratory Care International Congress, Las Vegas, NV. © 2014 Lehigh Valley Health NetworkIntroduction•		During	the	ventilation	of	patients	with	ARDS	one	of	the	primary	goals	is	to	minimize	ventilator	induced	injury.				•	If	the	oxygenation	end-point	cannot	be	achieved	by	conventional	ventilation,	ECMO	may	be	initiated.•		Ventilatory	management	becomes	even	more	complex	when	each	lung	exhibits	different	etiologies.	•		Management	is	especially	challenging	when	the	pathologic	process	differs	from	right	lung	to	left	lung.	ImagesPre independent lung ventilationCaseStudy•		We	describe	a	case	study	of	a	patient	with	H1N1	influenza	and	ARDS	requiring	ECMO	who	developed	multiple	pneumothoraces	of	the	right	lung	and	significant	consolidation	in	the	left	lung.		To	adequately	manage	the	patient,	independent	lung	ventilation	(ILV)	was	provided	by	two	Volumetric	Diffusive	Respirators	(VDR).12 hrs. post independent lung ventilation 48 hrs. post independent lung ventilationMethods•		A	twenty	four	year	old	female	was	admitted	with	H1N1	influenza	which	progressed	to	ARDS	requiring	ECMO.		On	day	fourteen	the	patient	developed	a	right	pneumothorax	which	was	decompressed	via	tube	thoracostomy.						•	Two	days	later,	pneumothorax	reoccurred	on	the	right	necessitating	placement	of	another	chest	tube	with	significant	air	leak.		Gas	exchange	deteriorated	(ABG	7.01/75/42)	oxygenation	and	sweep	gas	were	maximized	via	ECMO	with	marginal	improvement.		Radiographic	imaging	revealed	an	increasing	pneumothorax	of	the	right	lung	and	increasing	consolidation	of	the	left	lung.		•		The	decision	was	made	to	institute	independent	lung	ventilation	with	two	VDRs	via	dual	lumen	endotracheal	tube.		The	reason	HFPV	was	selected	as	a	ventilator	strategy	was	to	provide	lung	protection	to	the	injured	right	lung	(low	pressure/PEEP/percussive	force),	while	providing	aggressive	mucokinesis	for	the	obstructed	left	lung	(high	pressure/PEEP/percussive	force).	•		ECMO	settings	remained	at	100%/10LPM	sweep.HighFrequencyPercussiveVentilation•		Classified	as:  -  pneumatically driven  -  pressure limited  - time cycled   -  high frequency flow interrupter  -  delivers high frequency in a range of 200-900 cycles  - exhalation is passiveResults•		Within	forty-eight	hours	gas	exchange	had	improved	(ABG	7.32/48/76)	and	ECMO	parameters	were	weaned	to	80%/5	LPM	sweep.						•	Subsequently	the	patient	was	transitioned	to	conventional	ventilation	via	single	lumen	endotracheal	tube	with	no	deterioration	in	gas	exchange.	•		Radiographic	imaging	revealed	an	improvement	in	left	lung	consolidation.	 24 hrs. post transitionLehigh Valley Health Network, Allentown, PAThe Utilization of Independent Lung Ventilation Via High Frequency Percussive Ventilation (HFPV) During Extracorporeal Membrane Oxygenation (ECMO)Kenneth Miller MEd, RRT-ACCS, Rita Pechulis MD, James Wu MD, Chad Traub RRT-ACCS, Dorothea Watson MD

The Utilization of Independent Lung Ventilation Via High Frequency Percussive Ventilation (HFPV) During Extracorporeal Membrane Oxygenation (ECMO)

https://scholarlyworks.lvhn.org/cgi/viewcontent.cgi?article=1370&context=patient-care-services-nursing

The Utilization of Independent Lung Ventilation Via High Frequency Percussive Ventilation (HFPV) During Extracorporeal Membrane Oxygenation (ECMO)

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