שאלה

What would your recommendation be for giving bronchodilator to a baby on

HFOV? Would giving it in-line cause more barotrauma by the increase in

flow to nebulize the treatment or would handbagging the treatment cause

more harm due to loss of alveoli recruitment from disconnection? Thank

you for your input.

Mila Flores, CNS, NNP

PIH Whittier, CA

תשובה

Message: 1

    Date: Thu, 25 Dec 2003 09:19:40 +0000

    From: birdog@att.net

Subject: Re: Bronchodilator via HFOV

As with any other type of ventilator, you would reduce the flow to

compensate the flow given via the nebulizer. In the Sensormedics 3100A, we use the flow

to adjust our desired MAP, so if we give 5 LPM of flow via the neb, we would reduce the HFOV flow by 5 LPM, but only during the time of the treatment.

Many bronchodilators can be given by Metered Dose Inhalers, which would

resolve this issue. We do the same on our vents, except the Servo 300A, where we use an Ultrasonic Nebulizer(Siemens model 345)

Richard M. Hoskins RRT C-CPT CPFT

Neonatal Intensive Care

Respiratory Care Services NICU

Christus St. Joseph Hosp

Houston, Tx 77072

713-757-7564

Message: 2

    Date: Thu, 25 Dec 2003 07:12:15 -0600

    From: “Rob Trusty” <rob.trusty@childrenshc.org>

Subject: Re: Bronchodilator via HFOV

We don’t give nebs when they are on HFOV because we don’t want to lose what lung recruitment we have gotten and the way the flow works on the HFOV they would get very little if any of the brochodilator. If you neeed more info call your Sensormedics rep.

Rob Trusty RCP,RRT-NPS

Childrens Hospital and Clinics

345 No. Smith Av

St Paul MN 55102

Phone 651-220-6350

Pager 651-527-8127

Fax 651-220-6778

Rob.Trusty@childrenshc.org

Message: 3

    Date: Thu, 25 Dec 2003 13:37:01 -0600

    From: “David Purvin” <davidrcp@earthlink.net>

Subject: bronchodilator via HFOV

Hello Ms Flores,

I would get a small MDI connector and connect it between the end of the circuit and the ETT tube. You don’t have any worries about extra flow from an in-line neb and you don’t have to worry about disconnecting and losing Paw. Also a few thoughts. I don’t know that neccessarily adding flow from an inline neb would cause more barotrauma. The extra flow may just be automatically compensated for much like when you add in inline neb on the Drager. I don’t know as fact though that the HFOV does this.

Secondly, if it doesn’t compensate automatically, you could always adjust your Paw with the “limit” rather than the “adjust” on the vent.

This way if the added flow was an issue for the vent, the “limit” would act just like a dump valve. But, even if you were to use in-line nebs, you still have the problem of disconnecting and losing recruitment when it was time for the treatment. The only way I could see how you would be able to give a neb (i.e. disconnect and break the circuit) without losing your recruitment, would be to physically pinch the ETT (effectively trapping your Paw in the lungs), throw your inline treatment in, then restart the oscillator up to allow the circuit to

establish the Paw in the circuit and then un pinch the ETT.

Hope This Helps,

David Purvin, BS, RRT-NPS

Presbyterian Hospital

Dallas, TX

davidrcp@earthlink.net