Heliox administration during high-frequency jet ventilation augments carbon dioxide clearance.
We report the combined use of heliox and high-frequency jet ventilation to augment carbon dioxide clearance, with a focus on the important technical considerations. Our case is a 5-month old infant with acute respiratory failure associated with gas trapping, hypercarbia, respiratory acidosis, and air leak. Despite maximal conventional ventilation, bronchodilator therapy, corticosteroids, and sedation, the infant continued to demonstrate worsening gas exchange necessitating an escalation of support to high-frequency oscillatory ventilation. After the development of an air leak and continued difficulties with carbon dioxide clearance, the patient was transitioned to high-frequency jet ventilation. Persistent hypercarbia resulted in the addition of heliox to facilitate ventilation. Improvements in gas exchange occurred rapidly. The combination of heliox and high frequency jet ventilation resulted in improved carbon dioxide clearance, respiratory stabilization, and the ability to wean ventilator settings.
Gupta
Vineet K
VK
Division of Pediatric Critical Care, Duke University Medical Center, Durham, NC, USA. vineet_gupta@mhsnr.org.
Grayck
Eva N
EN
Cheifetz
Ira M
IM
D000208:Acute Disease; D000403:Airway Resistance / Q000187:drug effects; D002245:Carbon Dioxide / Q000378:metabolism*; D003131:Combined Modality Therapy; D005500:Follow-Up Studies; D006371:Helium / Q000627:therapeutic use*; D006611:High-Frequency Jet Ventilation / Q000379:methods*; D006801:Humans; D007223:Infant; D015278:Intensive Care Units, Pediatric; D010100:Oxygen / Q000627:therapeutic use*; D011659:Pulmonary Gas Exchange; D012129:Respiratory Function Tests; D012131:Respiratory Insufficiency / Q000175:diagnosis / Q000628:therapy*; D018570:Risk Assessment; D012720:Severity of Illness Index; D016896:Treatment Outcome
D002245:Carbon Dioxide; D006371:Helium; C038949:heliox; D010100:Oxygen