A Tale of Two Oscillators
Earlier this year, I had two very different oscillator experiences. The difference between PICU and NICU can be amazing. I work both but have a preference for (and more experience in) NICU.
I worked New Year's in NICU and had two oscillators. Both were stable, chronic kids that had just figured out that they liked high frequency and decided to stick with it. They were both on normal-ish settings for NICU, MAPs of 18-20 and Delta P's in the low to mid 30s with a hertz of 8. It was status quo, and we had no bumps in the road that night.
The next weekend, I was in PICU with yet another oscillator. This one was an 8-year-old girl and her setting blew my mind. She was on a MAP of 45, a Delta P of 120 and a hertz of 2. I was totally shocked with how huge those seemed.
She had a whole body wiggle going on, not just down to the hips like we're used to. In spite of these high settings that had even PICU core therapists shaking their heads, her blood gases were terrible. Her CO2s were in the 90s no matter what we did. She has a leak around her cuff, had been suctioned thoroughly, and had a very stable CXR with good tube position. We had figured pneumos or an effusion, but there was no evidence of either one. We were all stumped. They only thing to do was go up on her settings.
We turned up the MAP to 48 and the Delta P to 130, but it only made the tiniest dent in her CO2. We deferred to the next shift as they came on. They had no other ideas, and I went home puzzled.
When I came back that night, I got in report that her CO2s had stayed high until 10 a.m. and then just dropped to the 60s. No rhyme or reason, they just went down and stayed down.
Until 10 p.m. Then, they shot back up into the 90s and we couldn't get them down no matter what we did. It was a frustrating night for all of us in PICU. Sure enough, day shift came on and we went home again.
Around 10 a.m., her CO2s just dropped to the 60s again for no reason. Not wanting to look a gift horse in the mouth, day shift just let it be and counted their blessings.
I was off the next few nights but heard the same thing was happening. CO2s would shoot up into the 90s around 10 p.m. and back down to the 60s around 10 a.m. This pattern repeated for almost a week. No one ever did figure out what caused it, she just stopped having yucky gases all of a sudden and was weaned to conventional ventilation and then eventually off.
She went home less than two weeks after her battle with the oscillator. I guess as much as we do know about medicine, we still don't know it all. Her prognosis was grim, but she fought through and walked out of the hospital.
This just goes to show the amazing resiliency of children and the fact that one machine can be worlds apart in two different areas.
--Stephanie