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HFOV – Adult Case Study

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.

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HFOV – Adult Case Study

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  1. HFOV – Adult Case Study

  2. 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

  3. Admission

  4. HFOV Case Study • Pt transported to OR for fx repair – VSS • 24 hours later pt developed respiratory distress • CXR revealed diffuse patchy infiltrates

  5. ABG’s

  6. ABG’s

  7. 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

  8. ABG’s

  9. ABG’s

  10. HFOV Case Study • Although ABG’s improved, pt became increasingly agitated • RR  30’s • High pressure limit • BP, HR  • SaO2  40’s

  11. Pre HFOV – 4/21 – 11:00 hrs

  12. 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

  13. ABG’s

  14. ABG’s

  15. ABG’s

  16. ABG’s

  17. HFOV – 4/22 – 04:39 hrs

  18. ABG’s

  19. HFOV – 4/23 – 10:26 hrs

  20. Transition to CMV • PCV • PIP = 30cmH2O • Vt = 680 (wt 75kg) • FiO2 = .60 • PEEP = 5cmH2O • ABG • 7.47/44/62 • PCV • PIP  20cmH2O, PEEP  8cmH2O

  21. ABG’s

  22. PCV – 4/24 – 07:58 hrs

  23. ABG’s

  24. ABG’s

  25. 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

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