A Method for Determining Optimal Mean Airway Pressure in High-Frequency Oscillatory Ventilation

Casserly, Brian; McCool, F. Dennis; Sethi, Jigme M.; Kawar, Eyad; Read, Richard; Levy, Mitchell M.

doi:10.1007/s00408-012-9434-4

Cited by 5 publications

(5 citation statements)

References 29 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…12 Because the precision of magnetometry-derived values of ∆EELV with overweight and obese subjects presenting for PSG is unknown, we performed a validation study on 11 subjects who were referred for PSG. A computer-based, handheld spirometer (HDpft 1000, nSpire Health, Longmont, Colorado, United States) was brought to the subject's room in the sleep center.…”

Section: Validation Of Magnetometer-derived ∆Eelv In Subjects Presentmentioning

confidence: 99%

Change in End-Expiratory Lung Volume During Sleep in Patients at Risk for Obstructive Sleep Apnea

Koo

Gartman

Sethi

et al. 2017

Journal of Clinical Sleep Medicine

Self Cite

View full text Add to dashboard Cite

Study Objectives: As lung volume decreases radial traction on the upper airway is reduced, making it more collapsible. The purpose of this study was to measure change in end-expiratory lung volume (EELV) following sleep onset and to evaluate the relationship between change in EELV and sleep-disordered breathing. Methods: Twenty subjects underwent overnight polysomnography, of whom 14 (70%) had obstructive sleep apnea (OSA). Change in EELV was measured throughout the night using magnetometry. Sleep was staged and respiratory events scored using American Academy of Sleep Medicine criteria. An additional 10 subjects had change in EELV measured simultaneously by magnetometer and spirometer while awake. Results: In the subjects studied while awake, change in EELV calculated from magnetometer data correlated very strongly (r = 0.89, P < .001) with that obtained by spirometry. In the 20 subjects who underwent polysomnography, there was a decline in EELV for sleep stages N1, N2, N3, and R (REM sleep); 17.9 ± 121.0 mL (mean ± standard deviation), 228.5 ± 151.8 mL, 198.1 ± 122.1 mL, and 316.7 ± 131.9 mL, respectively. Mean EELV reduction during stage R sleep doubled that noted during non-stage R sleep (316.7 ± 131.9 mL versus 150.9 ± 89.7 mL, respectively) (P < .001). The difference in EELV between non-stage R and stage R sleep inversely correlated with mean oxygen saturation (r = −0.56, P = .06). EELV reduction in individuals with moderate and severe OSA was greater than in those with mild SDB but did not reach statistical significance. Conclusions:Magnetometry provides a precise, unobtrusive, and continuous means to study lung volume changes during sleep. EELV declines from sleep onset, reaching its nadir during stage R sleep. The reduction in EELV in stage R sleep was associated with lower mean oxygen saturation but was not associated with greater sleep-disordered breathing. Keywords: end-expiratory lung volume, magnetometry, REM sleep, sleep-disordered breathing Citation: Koo P, Gartman EJ, Sethi JM, Kawar E, McCool FD. Change in end-expiratory lung volume during sleep in patients at risk for obstructive sleep apnea. J Clin Sleep Med. 2017;13(8):941-947.

show abstract

Section: Validation Of Magnetometer-derived ∆Eelv In Subjects Presentmentioning

confidence: 99%

Change in End-Expiratory Lung Volume During Sleep in Patients at Risk for Obstructive Sleep Apnea

Koo

Gartman

Sethi

et al. 2017

Journal of Clinical Sleep Medicine

Self Cite

View full text Add to dashboard Cite

show abstract

“…The recruitment maneuvers were well-tolerated, with 3.3% were stopped due to hemodynamic instability ( Ferguson et al, 2005 ). Casserly et al evaluated a method to determine the optimal mPaw in seven subjects and assessed changes in end-expiratory lung volume by measuring chest wall dimensions ( Casserly et al, 2013 ). After a recruitment maneuver (40 cmH 2 O for 40 s), the mPaw was set at 35 cmH 2 O for 15 min, then reduced by 2.5 cmH 2 O every 15 min until the PaO 2 was <60 mmHg or mPaw was 15 cmH 2 O.…”

Section: Introductionmentioning

confidence: 99%

“…After a recruitment maneuver (40 cmH 2 O for 40 s), the mPaw was set at 35 cmH 2 O for 15 min, then reduced by 2.5 cmH 2 O every 15 min until the PaO 2 was <60 mmHg or mPaw was 15 cmH 2 O. Lung volume was found to increase in a sigmoid shape, as did PaO 2 , although PaCO 2 had a U-shaped curve as mPaw increased ( Casserly et al, 2013 ).…”

Section: Introductionmentioning

confidence: 99%

The Physiological Basis of High-Frequency Oscillatory Ventilation and Current Evidence in Adults and Children: A Narrative Review

Miller

Tan²,

Smith³

et al. 2022

Front. Physiol.

View full text Add to dashboard Cite

High-frequency oscillatory ventilation (HFOV) is a type of invasive mechanical ventilation that employs supra-physiologic respiratory rates and low tidal volumes (VT) that approximate the anatomic deadspace. During HFOV, mean airway pressure is set and gas is then displaced towards and away from the patient through a piston. Carbon dioxide (CO2) is cleared based on the power (amplitude) setting and frequency, with lower frequencies resulting in higher VT and CO2 clearance. Airway pressure amplitude is significantly attenuated throughout the respiratory system and mechanical strain and stress on the alveoli are theoretically minimized. HFOV has been purported as a form of lung protective ventilation that minimizes volutrauma, atelectrauma, and biotrauma. Following two large randomized controlled trials showing no benefit and harm, respectively, HFOV has largely been abandoned in adults with ARDS. A multi-center clinical trial in children is ongoing. This article aims to review the physiologic rationale for the use of HFOV in patients with acute respiratory failure, summarize relevant bench and animal models, and discuss the potential use of HFOV as a primary and rescue mode in adults and children with severe respiratory failure.

show abstract

“…An improperly high level of CDP can lead to ventilatorinduced lung injury. Many studies have been performed with an aim to obtain an optimal setting for CDP [21][22][23][24][25][26][27][28]. However, none of the suggested approaches have been broadly implemented in clinical practice, and CDP is commonly being set as a value of the mean airway pressure from the preceding CMV increased by several cmH 2 O [25].…”

Section: Introductionmentioning

confidence: 99%

In Vitro Estimation of Relative Compliance during High-Frequency Oscillatory Ventilation

et al. 2021

View full text Add to dashboard Cite

High-frequency oscillatory ventilation (HFOV), which uses a small tidal volume and a high respiratory rate, is considered a type of protective lung ventilation that can be beneficial for certain patients. A disadvantage of HFOV is its limited monitoring of lung mechanics, which complicates its settings and optimal adjustment. Recent studies have shown that respiratory system reactance (Xrs) could be a promising parameter in the evaluation of respiratory system mechanics in HFOV. The aim of this study was to verify in vitro that a change in respiratory system mechanics during HFOV can be monitored by evaluating Xrs. We built an experimental system consisting of a 3100B high-frequency oscillatory ventilator, a physical model of the respiratory system with constant compliance, and a system for pressure and flow measurements. During the experiment, models of different constant compliance were connected to HFOV, and Xrs was derived from the impedance of the physical model that was calculated from the spectral density of airway opening pressure and spectral cross-power density of gas flow and airway opening pressure. The calculated Xrs changed with the change of compliance of the physical model of the respiratory system. This method enabled monitoring of the trend in the respiratory system compliance during HFOV, and has the potential to optimize the mean pressure setting in HFOV in clinical practice.

show abstract

A Method for Determining Optimal Mean Airway Pressure in High-Frequency Oscillatory Ventilation

Abstract: The finding that MAP at the PMC is the same whether determined by measures of ∆EELV or PaO(2) suggest that bedside measures PaO(2) may provide an acceptable surrogate for measures of EELV when determining "optimal" MAP during HFOV.

Cited by 5 publications

References 29 publications

Change in End-Expiratory Lung Volume During Sleep in Patients at Risk for Obstructive Sleep Apnea

Change in End-Expiratory Lung Volume During Sleep in Patients at Risk for Obstructive Sleep Apnea

The Physiological Basis of High-Frequency Oscillatory Ventilation and Current Evidence in Adults and Children: A Narrative Review

In Vitro Estimation of Relative Compliance during High-Frequency Oscillatory Ventilation

Contact Info

Product

Resources

About