Combined Pressure Control/High Frequency Ventilation in Adult Respiratory Distress Syndrome and Sickle Cell Anemia
Patients with sickle cell disease-related acute chest syndrome often progress rapidly to adult respiratory distress syndrome (ARDS), necessitating endotracheal intubation and positive pressure ventilation.
Aggressive intensive care, including the judicious use of positive end-expiratory pressure (PEEP), has not substantially changed the high morbidity and mortality, although exchange transfusion is credited with some improvement in survival. Air leaks are a frequent complication of the ventilatory strategies used to adequately oxygenate patients with ARDS purchase birth control pills.
As the major factor in mechanical ventilation-associated extra-alveolar air leaks is barotrauma related to the use of large tidal volumes, ie, volutrauma, recent efforts to utilize smaller tidal volumes and limit overstretching of the alveoli and small airways include permissive hypercapnia, inverse ratio ventilation (IRV), airway pressure release ventilation, and high-frequency ventilation (HFV). No strategy has been shown to be uniformly effective, though HFV has the theoretic advantage of dramatically limiting tidal volume. However, the use of HFV outside the neonatal period has proved technically difficult.
We report the use of a combined mode ventilatory approach involving HFV superimposed on a background pressure control mode in a patient with sickle cell anemia who developed acute chest syndrome with ARDS. The patient developed severe extra-alveolar air leaks during conventional mechanical ventilation, and was successfully treated with the programmable volumetric diffusive ventilator (PVDV; Percussionaire Inc, Sandpoint, Idaho). A 3.8-year-old Hispanic boy with sickle cell anemia was admitted to the hospital with severe low back and mid-abdominal pain and a respiratory rate of 32 per min. Over the next 24 h, he developed abdominal distention with decreased bowel sounds. Radiographs revealed a mild ileus without lung infiltrates. On the third hospital day, he had a fever and patchy bibasilar and left upper lung infiltrates that coalesced within 8 h despite antibiotic therapy.
Category: Respiratory Symptoms
Tags: barotrauma, high frequency ventilation, sickle cell anemia