High-frequency percussive ventilation for intercontinental aeromedical evacuation

Authors

  • COL David J. Barillo, MD, FACS, FCCM
  • COL Evan M. Renz, MD
  • SFC Gabriel R. Wright, CRT
  • MAJ Kristine P. Broger, CCRN
  • LTC Kevin K. Chung, MD
  • Charles K. Thompson, PA-C
  • COL Leopoldo C. Cancio, MD, FACS

DOI:

https://doi.org/10.5055/ajdm.2011.0075

Keywords:

burn, trauma, aeromedical transport, high-frequency percussive ventilation, critical care air transport

Abstract

High-frequency percussive ventilation (HFPV) has been used for the management of patients with smoke inhalation injury for more than 20 years and is considered a standard of care at many burn centers. Because the ventilator is powered by air and oxygen rather than electricity, prehospital use has been limited by largevolume medical gas requirements.
Since 2003, Operations Iraqi Freedom and Enduring Freedom have created a need for long-range aeromedical transfer of service members with severe burn and inhalation injuries. Unique to these conflicts is the availability of US Air Force C-17 cargo aircraft as the primary longdistance airframe. Because C-17 aircraft have a built-in medical oxygen supply, transcontinental patient transport using HFPV has become feasible.
In this study, the authors report their initial experiences with the aeromedical transportation of 33 burn patients over a combined distance of 174,145 air miles using HFPV. HFPV is safe and efficacious for transcontinental flight when used by an experienced medical transport team.

Author Biographies

COL David J. Barillo, MD, FACS, FCCM

Burn Flight Team, US Army Institute of Surgical Research, Fort Sam Houston, Texas.

COL Evan M. Renz, MD

Clinical Division, US Army Institute of Surgical Research, Fort Sam Houston, San Antonio, Texas.

SFC Gabriel R. Wright, CRT

US Army Burn Center, US Army Institute of Surgical Research, Fort Sam Houston, San Antonio, Texas.

MAJ Kristine P. Broger, CCRN

US Army Burn Center, US Army Institute of Surgical Research, Fort Sam Houston, San Antonio, Texas.

LTC Kevin K. Chung, MD

US Army Burn Center, US Army Institute of Surgical Research, Fort Sam Houston, San Antonio, Texas.

Charles K. Thompson, PA-C

US Army Burn Center, US Army Institute of Surgical Research, Fort Sam Houston, San Antonio, Texas.

COL Leopoldo C. Cancio, MD, FACS

US Army Burn Center, US Army Institute of Surgical Research, Fort Sam Houston, Texas.

References

Blanch L, Villar J, Lopez Aguilar J: High frequency percussive ventilation: An old mode with a great future. Crit Care Med. 2009; 37(5): 1810-1811.

Harrington D: Volume diffuse ventilator. J Burn Care Res. 2009; 30(1): 175-176.

Cioffi WG, Graves TA, McManus WF, et al.: High-frequency percussive ventilation in patients with inhalation injury. J Trauma. 1989; 29: 350-354.

Gallagher TJ, Boysen PG, Davidson DD, et al.: High-frequency percussive ventilation compared with conventional mechanical ventilation. Crit Care Med. 1989; 17: 364-366.

Cioffi WG, Rue LW, Graves TA, et al.: Prophylactic use of high-frequency percussive ventilation in patients with inhalation injury. Ann Surg. 1991; 213: 575-582.

Rodeberg DA, Housinger TA, Greenhalgh DG, et al.: Improved ventilatory function in burn patients using volumetric diffusive ventilation. J Am Coll Surg. 1994; 179: 518-522.

Mlcak R, Cortiella J, Desai M, et al.: Lung compliance, airway resistance, and work of breathing in children after inhalation injury. J Burn Care Rehabil. 1997; 18: 531-534.

Reper P, Dankaert R, van Hille F, et al.: The usefulness of combined high-frequency percussive ventilation during acute respiratory failure after smoke inhalation. Burns. 1998; 24: 34-38.

Cortiella J, Mlcak R, Herndon D: High frequency percussive ventilation in pediatric patients with inhalation injury. J Burn Care Rehabil. 1999; 20: 232-235.

Boots RJ, Dulhunty JM, Paratz J, et al.: Respiratory complications of burns. Clin Pulm Med. 2009; 16(3): 132-138.

Hall JJ, Hunt JL, Arnoldo BD, et al.: Use of high-frequency percussive ventilation in inhalation injuries. J Burn Care Res. 2007; 28: 396-400.

Carman B, Cahill T,Warden G, et al.: A prospective randomized comparison of the volume diffusive respirator® versus conventional ventilation for ventilation of burned children. J Burn Care Rehabil. 2002; 23: 444-448.

Mlcak RP, Suman OE, Sanford AP, et al.: Comparison of high frequency percussive ventilation and conventional. J Burns Surg Wound Care. 2002; 1(1): 19 (serial online).

Fitzpatrick JC, Cioffi WG, Cheu HW, et al.: Predicting ventilation failure in children with inhalation injury. J Pediatr Surg. 1994; 29(8): 1122-1126.

Cioffi WG, deLemos RA, Coalson JJ, et al.: Decreased pulmonary damage in primates with inhalation injury treated with highfrequency ventilation. Ann Surg. 1993; 218(3): 328-337.

Rue LW, Cioffi WG, Mason AD, et al.: Improved survival of burned patients with inhalation injury. Arch Surg. 1993; 128: 772-780.

Reper P,Wibaux O, Van Laeke P, et al.: High frequency percussive ventilation and conventional ventilation after smoke inhalation: A randomized study. Burns. 2002; 28(5): 503-508.

Salim A, Martin M: High-frequency percussive ventilation. Crit Care Med. 2005; 33(3): S241-S245.

Reper P, Van Bos R, Van Loey K, et al.: High frequency percussive ventilation in burn patients: Hemodynamics and gas exchange. Burns. 2003; 29: 603-608.

Hurst JM, Branson RD, DeHaven CB: The role of high-frequency ventilation in post-traumatic respiratory insufficiency. J Trauma. 1987; 27: 236-242.

Hurst JM, Branson RD, Davis K: High-frequency percussive ventilation in the management of elevated intracranial pressure. J Trauma. 1988; 28: 1363-1367.

Nates JL, Cravens J, Hudgens C, et al.: Effects of volumetric diffusive respiration with normal or inverse I:E ratio on intracranial pressure. Crit Care Med. 1999; 27: A73 (abstract).

Salim A, Miller K, Dangleben D, et al.: High-frequency percussive ventilation: An alternative mode of ventilation for head-injured patients with adult respiratory distress syndrome. J Trauma. 2004: 57: 542-546.

Pfenninger J, Gerber AC: High-frequency ventilation (HFV) in hyaline membrane disease: A preliminary report. Intensive Care Med. 1987; 13: 71-75.

Pfenninger J, Minder C: Pressure-volume curves, static compliances and gas exchange in hyaline membrane disease during conventional mechanical and high-frequency ventilation. Intensive Care Med. 1988; 14: 364-372.

White CE, Park MS, Renz EM, et al.: Burn center treatment of patients with severe anhydrous ammonia injury: Case reports and literature review. J Burn Care Res. 2007; 28: 922-928.

Mabe TG, Honeycutt T, Cairns BA, et al.: High-frequency percussive ventilation in a pediatric patient with hydrocarbon aspiration. Pediatr Crit Care Med. 2007; 8: 383-386.

Lucangelo U, Antonaglia V, Zin WA, et al.: High-frequency percussive ventilation improves peri-operatively clinical evolution in pulmonary resection. Crit Care Med. 2009; 37(5): 1663-1669.

Lucangelo U, Zin WA, Antonaglia V, et al.: High-frequency percussive ventilation during surgical bronchial repair in a patient with one lung. Brit J Anesth. 2006; 96(4): 533-536.

Baird JS, Johnson JL, Escudero J, et al.: Combined pressure control/ high frequency ventilation in adult respiratory distress syndrome and sickle cell anemia. Chest. 1994; 106: 1913-1916.

Heringlake M, Schumacher J, Sedemund-Adib B, et al.: Bronchial stenting and high-frequency percussive ventilation treatment of descending aortic aneurysm-induced atelectesis of the left lung. Anesth Analg. 2002; 95: 1189-1191.

Paulsen SM, Killyon GW, Barillo DJ: High frequency percussive ventilation as a salvage modality in adult respiratory distress syndrome: A preliminary study. Am Surg. 2002; 68(10): 852-856.

Velmahos GC, Chan LS, Tatevossian R, et al.: High-frequency percussive ventilation improves oxygenation in patients with ARDS. Chest. 1999; 116: 440-446.

Barillo DJ, Dickerson EE, Cioffi WG, et al.: Pressure-controlled ventilation for the long-range aero-medical transport of patients with burns. J Burn Care Rehabil. 1997; 18: 200-205.

Hall BH,Yoder BA, Stribley RF: Evaluation of a hybrid high-frequency ventilator in a surfactant deficient rabbit model at simulated altitude. Pediatr Res. 1996; 39(4): 213 (abstract).

Honey G, Bleak T, Karp T, et al.: Use of the Duotron transport high frequency ventilator during neonatal transport. J Neonatal Nurs. 2007; 26(3): 167-174.

Park MS, Canrio LC, Batchinsky AI, et al.: Assessment of severity of ovine smoke inhalation injury by analysis of computed tomographic scans. J Trauma. 2003; 55(3): 417-429.

Galvez E, Park MS, Harshbarger TL, et al.: Evaluation of the Duotron, a high frequency pressure cycled transport ventilator. J Burn Care Rehabil. 1999; 20(1): S201; part 2.

Barillo DJ, Cancio LC, Kim SH, et al.: Fatal and nearfatal complications of liposuction. South Med J. 1998; 91(5): 487-492.

Cancio LE, Vanputte W: Development of the SMEED platform. US Army Med Dept J. 2003; July-September: 9-11.

Barillo DJ, Cancio LC, Stack RS, et al.: Deployment and operation of a transportable burn intensive care unit in response to a burn multiple casualty incident. Am J Disaster Med. 2010; 5(1): 5-13.

Carlton PK Jr: Forward. In Hurd WW, Jernigan JG (eds.): Aeromedical Evacuation Management of Acute and Stabilized Patients. New York: Springer-Verlag, 2003.

Hurd WW, Jernigan JG: Introduction. In Hurd WW, Jernigan JG (eds.): Aeromedical Evacuation Management of Acute and Stabilized Patients. New York: Springer-Verlag, 2003.

Renz EM, Cancio LC, Barillo DJ, et al.: Long range transport of war-related burn casualties. J Trauma. 2008; 64(2 Suppl): S136- S144.

Waggoner RR: Flight physiology. In Lee G (ed.): Flight Nursing, Principles and Practice. St Louis: Mosby-Yearbook, 1991.

Bendrick GA, Nicolas DK, Krause BA, et al.: In-flight oxygen saturation decrements in aeromedical evacuation patients.Aviat Space Environ Med. 1995; 66: 40-44.

Mozingo DW, Barillo DJ, Pruitt BA Jr: Acute resuscitation and transfer management of burned and electrically injured patients. Trauma Quart. 1994; 11(2): 94-113.

Branson RD, McGough EK: Transport ventilators. Probl Crit Care. 1990; 4(2): 254-274.

Chipman DW, Caramez MP, Miyoshi E, et al.: Performance comparison of 15 transport ventilators. Resp Care. 2007; 52(6): 740- 751.

Rodriquez D, Branson RD, Dorlac W, et al.: Effects of simulated altitude on ventilator performance. J Trauma. 2009; 66 (4 Suppl): S172-S177.

Published

11/01/2011

How to Cite

Barillo, MD, FACS, FCCM, C. D. J., C. E. M. Renz, MD, S. G. R. Wright, CRT, M. K. P. Broger, CCRN, L. K. K. Chung, MD, C. K. Thompson, PA-C, and C. L. C. Cancio, MD, FACS. “High-Frequency Percussive Ventilation for Intercontinental Aeromedical Evacuation”. American Journal of Disaster Medicine, vol. 6, no. 6, Nov. 2011, pp. 369-78, doi:10.5055/ajdm.2011.0075.

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