Oscillator Vents and ARDS

[Cindy-san]

Just curious.

How many of you and how often and at what point do you use those oscillator vents in people with ARDS (or other conditions)?

I floated to (adult) SICU the other day and they had an ARDS pt on one. I had never seen one before (they "looked for one" at my previous job, but couldn't find it and didn't rent one), so I was quite curious. RT gave me a quick inservice and told me that the patient had been on a regular vent a few days before, but they were having a lot of trouble oxygenating her (suprise, suprise) and the CO2 was hanging around the 120's! They were at the point of ECMO and decided to try the oscillator first. Fortunately, it's been working very well for the pt.

Outside of NICU, it doesn't seem to be standard fare at my hospital for ARDS. They certainly seem to prefer ECMO on my unit....

So, how about your hospitals?

[Creamsoda, ASN, RN]

I work in a large Adult ICU. We dont use them very often. Well hardly ever. I think in the last 2.5 years, there were maybe 4 patients who we have used them on. 2 or 3 of them had necrotizing MRSA and they kept blowing pneumos and couldnt oxygenate them. so they put them on the occilator. I cant remember why the other guy had it, but he did die within a few days I beleive anyway. I had never seen them before I worked here, but they are neat. I am not really very familiar with exactly how they work, just the very basics as the RT dealt with it. but it was within a space of a few months that we had all these cases, so our unit finally decided to buy one as we were borrowing from another hospital.

[Nurseboy1]

My unit and the SICU in my hospital are two of the high volume units for the oscillator. We frequently oscillate patients for severe ARDS and the SICU often oscillates for severe pulmonary contusions. There are occasions on both units where we will have more than one oscillated patient at the time.

[slcpicu]

To answer your first question. We calculate an oxygen index (OI) on these patients needing increased vent support and worsing abg's. If the OI is approaching 20 (most of the time more like >15) we will place them on HFOV. If the OI is >25, we then start to think about elective cannulation for ecmo support. (if that's even an option)