Disease severity and optimum mean airway pressure level on transfer to high frequency oscillation

1994 ◽  
Vol 17 (3) ◽  
pp. 178-182 ◽  
Author(s):  
V. Chan ◽  
A. Greenough ◽  
F. Giffin
Keyword(s):  
Disease Severity ◽  
High Frequency ◽  
Airway Pressure ◽  
Pressure Level ◽  
High Frequency Oscillation ◽  
Mean Airway Pressure ◽  
Frequency Oscillation

Optimal Mean Airway Pressure during High-frequency Oscillation

2001 ◽  
Vol 94 (5) ◽  
pp. 862-869 ◽  
Author(s):  
Sven Goddon ◽  
Yuji Fujino ◽  
Jonathan M. Hromi ◽  
Robert M. Kacmarek
Keyword(s):  
Acute Respiratory Distress Syndrome ◽  
Respiratory Distress Syndrome ◽  
High Frequency ◽  
Airway Pressure ◽  
Distress Syndrome ◽  
High Frequency Oscillation ◽  
Positive End Expiratory Pressure ◽  
Mean Airway Pressure ◽  
Frequency Oscillation ◽  
Initial Injury

Background A number of groups have recommended setting positive end-expiratory pressure during conventional mechanical ventilation in adults at 2 cm H2O above the lower corner pressure (P(CL)) of the inspiratory pressure-volume (P-V) curve of the respiratory system. No equivalent recommendations for the setting of the mean airway pressure (Paw) during high-frequency oscillation (HFO) exist. The authors questioned if the Paw resulting in the best oxygenation without hemodynamic compromise during HFO is related to the static P-V curve in a large animal model of acute respiratory distress syndrome. Methods Saline lung lavage was performed in seven sheep (28+/-5 kg, mean +/- SD) until the arterial oxygen partial pressure/fraction of inspired oxygen ratio decreased to 85+/-27 mmHg at a positive end-expiratory pressure of 5 cm H2O (initial injury). The PCL (20+/-1 cm H2O) on the inflation limb and the point of maximum curvature change (PMC; 26+/-1 cm H2O) on the deflation limb of the static P-V curve were determined. The sheep were subjected to four 1-h cycles of HFO at different levels of Paw (P(CL) + 2, + 6, + 10, + 14 cm H2O), applied in random order. Each cycle was preceded by a recruitment maneuver at a sustained Paw of 50 cm H2O for 60 s. Results High-frequency oscillation with a Paw of 6 cm H2O above P(CL) (P(CL) + 6) resulted in a significant improvement in oxygenation (P < 0.01 vs. initial injury). No further improvement in oxygenation was observed with higher Paw, but cardiac output decreased, pulmonary vascular resistance increased, and oxygen delivery decreased at Paw greater than P(CL) + 6. The PMC on the deflation limb of the P-V curve was equal to the P(CL) + 6 (r = 0.77, P < 0.05). Conclusion In this model of acute respiratory distress syndrome, optimal Paw during HFO is equal to P(CL) + 6, which correlates with the PMC.

A new system for ventilating with high-frequency oscillation

1982 ◽  
Vol 53 (6) ◽  
pp. 1638-1642 ◽  
Author(s):  
Y. K. Ngeow ◽  
W. Mitzner
Keyword(s):  
Tidal Volume ◽  
High Frequency ◽  
Airway Pressure ◽  
Ventilation System ◽  
High Frequency Oscillation ◽  
High Frequency Ventilation ◽  
Mean Airway Pressure ◽  
Frequency Oscillation ◽  
Frequency Ventilation ◽  
New System

We describe simple high-frequency oscillation systems that incorporate a CO2 absorber and supply O2 on a need basis. These systems have the advantage of easy control of mean airway pressure and airway hydration and negligible loss of oscillatory tidal volume. Experiments done at constant tidal volume showed that as frequency (and hence total ventilation) increased, arterial CO2 tension (PaCO2) decreased. The fall in PaCO2 occurred until frequency reached approximately 20 Hz; above 20 Hz further increases in frequency had little or no effect on PaCO2. Because of their practical advantages the techniques described here may be quite useful in a clinical setting where an oscillator, rather than jet-type high-frequency, ventilation system is desired.

scholarly journals NASAL HIGH FREQUENCY OSCILLATION AND NASAL CONTINUOUS POSITIVE AIRWAY PRESSURE FOR RESPIRATORY INSUFFIENCY IN NEWBORN INFANTS 1946

1996 ◽  
Vol 39 ◽  
pp. 327-327
Author(s):  
Eric G Brouwer ◽  
Mark A van der Hoeven ◽  
Danillo W Gavilanes ◽  
Pieter L Degraeuwe ◽  
Wiel J Maertzdort ◽  
...  
Keyword(s):  
Continuous Positive Airway Pressure ◽  
High Frequency ◽  
Airway Pressure ◽  
Positive Airway Pressure ◽  
Newborn Infants ◽  
High Frequency Oscillation ◽  
Frequency Oscillation

scholarly journals High frequency oscillation and airway pressure release ventilation in pediatric respiratory failure

2013 ◽  
Vol 49 (7) ◽  
pp. 707-715 ◽  
Author(s):  
Nadir Yehya ◽  
Alexis A. Topjian ◽  
Richard Lin ◽  
Robert A. Berg ◽  
Neal J. Thomas ◽  
...  
Keyword(s):  
Respiratory Failure ◽  
High Frequency ◽  
Airway Pressure ◽  
Airway Pressure Release Ventilation ◽  
High Frequency Oscillation ◽  
Frequency Oscillation ◽  
Pressure Release ◽  
Pressure Release Ventilation

scholarly journals Airway Pressure and Transpulmonary Pressure During High-Frequency Oscillation for Acute Respiratory Distress Syndrome

2014 ◽  
Vol 21 (2) ◽  
pp. 107-111 ◽  
Author(s):  
William R Henderson ◽  
Paolo B Dominelli ◽  
Donald EG Griesdale ◽  
Daniel Talmor ◽  
A William Sheel
Keyword(s):  
Acute Respiratory Distress Syndrome ◽  
Respiratory Distress Syndrome ◽  
Respiratory Distress ◽  
High Frequency ◽  
Airway Pressure ◽  
Distress Syndrome ◽  
Balloon Catheter ◽  
Transpulmonary Pressure ◽  
High Frequency Oscillation ◽  
Frequency Oscillation

BACKGROUND: High-frequency oscillation (HFO) is used for the treatment of refractory hypoxic respiratory failure.OBJECTIVE: To demonstrate that the mean transpulmonary pressure (PL) cannot be inferred from mean airway pressure (mPaw).METHODS: In seven patients already undergoing HFO for refractory acute respiratory distress syndrome, esophageal pressure (Pes) was measured using an esophageal balloon catheter. Pleural pressure (Ppl) and PLwere calculated from Pes.MAIN RESULTS: In the seven patients (mean [± SD] age 59±9 years) treated with HFO at 5±1 Hz and amplitude 75±10 cmH2O, the mPaw was 27±6 cmH2O, Ppl was 9±6 cmH2O and PLwas 18±11 cmH2O. Successful catheter placement and measurement of Pes occurred in 100% of subjects. There was no correlation between PLand mPaw. The majority of subjects required hemodynamic support during the use of HFO; the frequency and degree of support during the study period was no different than that before the study.CONCLUSION: The present report is the first to describe measuring Pes and calculating Ppl during HFO for acute respiratory distress syndrome. While both current guidelines and recent trials have titrated treatment based on mPaw and oxygenation, there is wide variability in PLduring HFO and PLcannot be predicted from mPaw.

Lung volume recruitment during high-frequency oscillation in atelectasis-prone rabbits

1988 ◽  
Vol 64 (4) ◽  
pp. 1607-1614 ◽  
Author(s):  
L. J. Byford ◽  
J. H. Finkler ◽  
A. B. Froese
Keyword(s):  
Lung Volume ◽  
High Frequency ◽  
Airway Pressure ◽  
Random Order ◽  
High Frequency Oscillation ◽  
Mean Airway Pressure ◽  
Mean Pressure ◽  
Residual Capacity ◽  
Lung Volume Recruitment ◽  
Arterial Po2

In diffuse lung injury, optimal oxygenation occurs with high-frequency oscillatory ventilation (HFO-A, where A is active expiratory phase) when sustained inflations (SI) are applied periodically to recruit lung volume. Theoretically pulsed pressures may be safer and more effective than static pressures for reexpanding alveoli. We compared the increases in lung volume and arterial PO2 (PaO2) induced by 30-s increases in mean airway pressure in six New Zealand White rabbits made atelectasis prone by saline lavage plus 1 h of conventional ventilation. Pulsatile SI's (HFO-A left on during increase in mean pressure) of delta PSI = 5, 10, and 15 cmH2O and static SI's (HFO-A off during SI) of delta PSI = 5, 10, 15, and 20 cmH2O were delivered in random order. Lungs were ventilated at 15 Hz, inspired fractional concentration of O2 = 1.0, and mean airway pressure 15-20 cmH2O between test periods and deflated to functional residual capacity before each SI to standardize volume history. With both maneuvers, increases in lung volume and PaO2 induced by SI's were proportional to the magnitude of the SI (P less than 0.001) in all cases. Pulsatile SI's consistently increased lung volume and PaO2 more than static SI's having the same delta PSI (P less than 0.005) such that any given target PaO2 or change in volume (delta V) was achieved at 5 cmH2O less mean pressure with the pulsatile maneuver. Respiratory system compliance increased after both types of SI. Oxygenation and lung volume changes at 5 min were related with r = 0.58 (P less than 0.001).(ABSTRACT TRUNCATED AT 250 WORDS)

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