1/1/1999

The Children's Memorial Hospital in Chicago, IL. receives some difficult ventilatory support cases from all around the greater Chicago area and other states. Frequently, graduates of neonatal and pediatric intensive care units find their way to Children's Memorial Hospital because they require sophisticated weaning from acute, non-portable ventilatory support and preparation for placement in the home. These cases require expertise in mechanical ventilation, understanding of technical issues, and an appreciation of all the nuances of placing a ventilator in the home. This is the report of one such difficult case and the use of a new ventilator to solve some difficult problems.

The patient in this case was a beautiful six month-old little girl, former 34 week premie with history of bilateral plexus injury status post repair, right diaphragm paralysis status post plication status post tracheostomy, ventilator dependent, gastroesophageal reflux status post g-tube who was transferred to CMH on November 17, 1998 via fixed wing medical transport from Texas Children's Hospital following brachial nerve plexus repair, right diaphragm plication and g-tube placement. This patient was transferred to CMH because the parents are Illinois residents and this patient required continued observation and ventilatory management with plans for eventual discharge home on long term medical ventilation.

This patient was admitted to CMH PICU and place on the Servo 300 in the VCPS mode due to problems with a large air leak. Her trach was upsized by ENT to a 4.5 Neo Shiley. After one week with a stable TCM's ranging in the low to mid 30's, this patient was transferred to the TCU (Traditional Care Unit) on November 23, 1998.

One of the biggest difficulties was determining what equipment would be ideal to send this patient home on. She could not tolerate spontaneous breathing in between IMV breaths without the addition of continuous flow. Therefore, she could not tolerate the LP-10 or PLV-102. Consideration was given to using a non-invasive ventilator. However, this machine could not provide the support this patient needed. It would also represent a potential legal problem since BIPAP is considered non-invasive ventilation and this patient needed invasive ventilation due to her tracheostomy.

I had been made aware of a new ventilator which was comparable to the Servo 300 and the size of a lap-top computer which could be used for invasive and non-invasive ventilation, housing an internal battery that made ventilator portability phenomenal! On January 28, 1999 this patient was transitioned to the LTV1000 ventilator and required few ventilator adjustments over the following two weeks before finding settings on which she was comfortable awake and asleep. Her transition to the LTV1000 under the direction of Dr. Zehava Noah, myself and Cindy Budek NP, in the AC mode showed she was triggering the ventilator easily and breathing comfortably. We were able to utilize the sensitivity along with continuous flow feature to enhance her transition to the LTV1000.

We were very excited at her progress and the portability of the ventilator was ideal for the kind of active lifestyle we hoped to offer her when she went home. At just over 12 lbs. With the continuous flow feature, the LTV1000 ventilator was an answer for some of our chronic ventilator dependent children, who, like our little girl, are normal physically and mentally except for temporary and permanent respiratory impairment. The patient's parents were very anxious to get her home and expose her to all the things they felt she had missed. I began education with her family and caregivers for home. The LTV1000 is very user friendly which made this and easier task.

After approximately a month, all the preparations for taking her home were in place. Her transition to the home has been very successful and we expect that as she grows, she will be able to be weaned from the ventilator. The portability of the LTV1000 has allowed her to get around and experience life outside the hospital.

Children's Memorial Hospital is very grateful to Pulmonetic Systems, Inc. for introducing this ventilator to our facility. This gesture allowed us to be the first in the country to send a ventilator dependent patient home on the LTV1000, a portable ventilator with FDA clearance for both homecare and institutional use.