USE OF HIGH FREQUENCY PERCUSSIVE VENTILATION FOR ARDS

TOPIC: Critical Care TYPE: Medical Student/Resident Case Reports INTRODUCTION: High frequency percussive ventilation (HFPV) is a method of that delivers biphasic microvolumes in time-cycled, pressure limited fashion. The goal to increase recruitment alveoli burdened by secretions or atelectasis improve gas exchange for those failing conventional ventilation. HFPV has been utilized the acute inhalation injury population; however, its use spread medical community as rescue respiratory distress (ARDS) patients. CASE PRESENTATION: A 24-year-old male with past medial history type 2 diabetes, obstructive sleep apnea, and obesity presented Emergency Department worsening epigastric pain, nausea, vomiting. He was ill appearing diffuse abdominal guarding, rebound. Pertinent labs included lipase 3,600 U/L triglycerides 1,700 mg/dL. Computed tomography (CT) abdomen pelvis revealed severe pancreatic edema non-enhancing tail concerning necrosis. admitted Intensive Unit started on crystalloid infusion continuous insulin. developed progressive tachypnea ultimately required intubation hypoxemia. further decompensated fevers hypotension, requiring initiation broad-spectrum antibiotics vasopressors. Despite insulin infusion, patient's increased 9,500 mg/dL he therapeutic plasma exchange. Echocardiogram did not reveal evidence left ventricular dysfunction. Chest x-ray showed bilateral pulmonary infiltrates suggestive ARDS. lung-protective, volume-controlled ventilation, patient continued exhibit high plateau driving pressures. Given his significantly distended bladder pressures, unable tolerate prone positioning. PaO2/FiO2 ratio (P/F ratio) low 91. Subsequently underwent cannulation veno-venous extracorporeal membrane oxygenation (VV-ECMO). His secretion burden remained CT chest dense atelectasis. then switched better management improvement oxygenation. After 48 hours HFPV, had significant P/F ratio. eight days, decannulated from VV-ECMO later extubated. DISCUSSION: Our experienced known complications hypertriglyceride-induced pancreatitis. ARDS improved robustly support. In centers experience this it can be powerful tool patients suffering injury, high-secretion pneumonias, CONCLUSIONS: Though does have volume data supporting ARDS, appropriately selected provide safe efficient way improving lung recruitment, exchange, potentially outcomes. REFERENCE #1: Godet T, Jabaudon M, Blondonnet R, Tremblay A, Audard J, Rieu B, Pereira Garcier JM, Futier E, Constantin JM. increases alveolar early syndrome: an experimental, physiological scan study. Crit Care. 2018 Jan 11;22(1):3. #2: Spapen H, Borremans Diltoer M. Van Gorp V, Nguyen D, Honore P. (2014). High-frequency single center experience. Journal Anesthesiology Clinical Pharmacology. 30(1):65-70. DISCLOSURES: No relevant relationships Alaynna Kears, source=Web Response Christopher Lenivy, Kaitlyn Musco, Roshun Sangani, Daniel Schwed Lustgarten,