High-frequency oscillatory ventilation and an interventional lung assist device to treat hypoxaemia and hypercapnia
- 1 October 2004
- journal article
- case report
- Published by Elsevier in British Journal of Anaesthesia
- Vol. 93 (4) , 582-586
- https://doi.org/10.1093/bja/aeh231
Abstract
A male patient accidentally aspirated paraffin oil when performing as a fire-eater. Severe acute respiratory distress syndrome (Pa(o(2))/Fi(o(2)) ratio 10.7 kPa) developed within 24 h. Conventional pressure-controlled ventilation (PCV) with high airway pressures and low tidal volumes failed to improve oxygenation. Hypercapnia (Pa(co(2)) 12 kPa) with severe acidosis (pH<7.20) ensued. Treatment with high-frequency oscillatory ventilation (HFOV) and a higher adjusted airway pressure (35 cm H(2)O) improved the Pa(o(2))/Fi(o(2)) ratio within 1 h from 10.7 to 22.9 kPa, but the hypercapnia and acidosis continued. Stepwise reduction of the mean airway pressure (26 cm H(2)O), and oscillating frequencies (3.5 Hz), as well as increasing the oscillating amplitudes (95 cm H(2)O) resulted in an unchanged Pa(co(2)), but oxygenation worsened. The new pumpless extracorporeal interventional lung assist device (ILA, NovaLung, Hechingen, Germany) was therefore used for carbon dioxide elimination to enable a less aggressive ventilation strategy. Pa(co(2)) normalized after initiation of ILA. HFOV with a mean airway pressure of 32 cm H(2)O was maintained, but with a higher oscillatory frequency (9 Hz) and very low oscillatory amplitude (25 cm H(2)O). After 6 days, the patient was transferred to a conventional ventilator, and ILA was discontinued after 13 days without complications.Keywords
This publication has 8 references indexed in Scilit:
- High-frequency oscillatory ventilation in adult acute respiratory distress syndromeIntensive Care Medicine, 2003
- High-Frequency Oscillatory Ventilation for Acute Respiratory Distress Syndrome in AdultsAmerican Journal of Respiratory and Critical Care Medicine, 2002
- Pumpless extracorporeal lung assist and adult respiratory distress syndromeThe Lancet, 2000
- Pumpless extracorporeal lung assist – experience with the first 20 casesEuropean Journal of Cardio-Thoracic Surgery, 2000
- Arteriovenous carbon dioxide removal: development and impact on ventilator management and survival during severe respiratory failurePerfusion, 1999
- Pumpless Arterial-Venous Extracorporeal CO2 Removal During Acute Lung InjuryThe Journal of ExtraCorporeal Technology, 1996
- Randomized clinical trial of pressure-controlled inverse ratio ventilation and extracorporeal CO2 removal for adult respiratory distress syndrome.American Journal of Respiratory and Critical Care Medicine, 1994
- High Inflation Pressure Pulmonary Edema: Respective Effects of High Airway Pressure, High Tidal Volume, and Positive End-expiratory PressureAmerican Review of Respiratory Disease, 1988