Intensive Care, University Hospital of Wales, Cardiff, CF4 4XW, UK
Introduction
High Frequency Oscillator Ventilation (HFOV) is a novel lung protective strategy in the treatment of patient with acute respiratory distress syndrome (ARDS). Percutaneous tracheostomy (PCT) has become the preferred mode of achieving long-term airway in ventilated patients, to facilitate weaning and airway toileting.
Aim
To demonstrate the safety and practicability of performing a percutaneous tracheostomy on patients with ARDS whilst on a high frequency oscillator ventilator (HFOV).
Method
Percutaneous tracheostomy was performed using either Ciaglia serial dilatation or Ciaglia 'Blue Rhino' (CBR) techniques, once there was an improvement in gas exchange.
Results
See Table.
Patient no.
1
2
3
4
5
Age/sex
56/M
79/M
50/F
69/M
39/F
Days intubated pre-PCT
5
4
9
4
3
Days on HFOV
6
5
13
6
8
Total days ventilated
8
9
40
8
8
Complication of PCT
None
None
None
None
None
PCT technique
Serial
Serial
CBR
CBR
CBR
Mean airway pressure pre/post PCT
19/18
27/28
18/16
19/18
20/21
Amplitude (?
60/55
61/70
56/61
55/56
62/65
PaO2/FiO2 ratio pre/post PCT
210/215
177/202
200/205
240/268
220/200
Discussion
In our group of five patients we performed a percutaneous tracheostomy once we were sure that their lung injury was improving i.e. improved P/F ratio, with a decreasing mean airway pressure to achieve it. There was no worsening of gas exchange perioperatively, nor was there complication associated with the percutaneous tracheostomy.
Conclusion
It is safe to perform a PCT in patient with resolving ARDS on HFOV.