High-frequency oscillatory ventilation with volume guarantee: a single-centre experience

Belteki, Gusztav; Morley, C J

doi:10.1136/archdischild-2018-315490

Cited by 19 publications

(31 citation statements)

References 22 publications

(24 reference statements)

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“…Tight control of VThf and automatic adjustments in amplitude using HFOV-VG may be particularly useful when the respiratory mechanics change rapidly (6,8). Previous studies demonstrated that during HFOV-VG, the VThf can vary from 1 s to another, but it is kept very close to the target VThf in the long term (9). CO 2 excretion during HFOV is defined by the diffusion coefficient of CO2 (DCO 2 ) as an indicator of alveolar ventilation.…”

Section: Introductionmentioning

confidence: 99%

Volume Guarantee High-Frequency Oscillatory Ventilation in Preterm Infants With RDS: Tidal Volume and DCO2 Levels for Optimal Ventilation Using Open-Lung Strategies

et al. 2020

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High frequency oscillatory ventilation with volume-guarantee (HFOV-VG) is a promising lung protective ventilator mode for the treatment of respiratory failure in newborns. However, indicators of optimal ventilation during HFOV-VG mode are not identified yet. In this study, we aimed to evaluate optimal high-frequency tidal volume (VThf) and the dissociation coefficient of CO 2 (DCO 2 ) levels to achieve normocapnia during HFOV-VG after lung recruitment in very low birthweight infants with respiratory distress syndrome (RDS). Preterm babies under the 32nd postmenstrual week with severe RDS that received HFOV-VG using open-lung strategy between January 2014 and January 2019 were retrospectively evaluated. All included patients were treated with the Dräger Babylog VN500 ventilator in the HFOV-VG mode. In total, 53 infants with a mean gestational age of 26.8 ± 2.3 weeks were evaluated. HFOV mean optimal airway pressure (MAPhf) level after lung recruitment was found to be 10.2 ± 1.7 mbar. Overall, the mean applied VThf per kg was 1.64 ± 0.25 mL/kg in the study sample. To provide normocapnia, the mean VThf was 1.61 ± 0.25 mL/kg and the mean DCO 2 corr was 29.84 ± 7.88 [mL/kg] 2 /s. No significant correlation was found between pCO 2 levels with VThf (per kg) or DCO 2 corr levels. VThf levels to maintain normocarbia were significantly lower with 12 Hz frequency compared to 10 Hz frequency (1.50 ± 0.24 vs. 1.65 ± 0.25 mL/ kg, p < 0.001, respectively). A weak but significant positive correlation was found between mean airway pressure (MAPhf) and VThf levels. To our knowledge, this is the largest study to evaluate the optimal HFOV-VG settings in premature infants with RDS, using the open-lung strategy. According to the results, a specific set of numbers could not be recommended to achieve normocarbia. Following the trend of each patient and small adjustments according to the closely monitored pCO 2 levels seems logical.

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Section: Introductionmentioning

confidence: 99%

Volume Guarantee High-Frequency Oscillatory Ventilation in Preterm Infants With RDS: Tidal Volume and DCO2 Levels for Optimal Ventilation Using Open-Lung Strategies

et al. 2020

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“…The use of VG on HFOV at standard frequencies (7-12 Hz) has also been extended to other neonatal units, yielding less fluctuation in oxygen saturation and PCO 2 levels [19,[50][51][52].…”

Section: Discussionmentioning

confidence: 99%

“…In HFOV+VG mode (Babylog® VN500, Dräger, Lübeck, Germany), ventilators achieve VThf stability by automatically adjusting ΔPhf [18]. VThf fluctuates in the short term, but remains very close to the target value over longer periods [19]. The increase in ΔPhf necessary to maintain a constant VThf measured in the airway opening is damped as it traverses the airways to the alveoli, especially at higher frequencies [20][21][22], until it falls to a minimum at the resonant frequency, as described in several studies [21,[23][24][25][26].…”

Section: Introductionmentioning

confidence: 99%

“…The increase in ΔPhf necessary to maintain a constant VThf measured in the airway opening is damped as it traverses the airways to the alveoli, especially at higher frequencies [20][21][22], until it falls to a minimum at the resonant frequency, as described in several studies [21,[23][24][25][26]. This optimal frequency, which results in adequate gas transport during HFOV and the least harmful pressures, depends on underlying lung condition wherein higher frequencies are better suited to pulmonary diseases with low compliance and short time constants such as RDS in preterm infants [19,21].…”

Section: Introductionmentioning

confidence: 99%

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Effect of a new respiratory care bundle on bronchopulmonary dysplasia in preterm neonates

et al. 2020

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The development of devices that can fix the tidal volume in high-frequency oscillatory ventilation (HFOV) has allowed for a significant improvement in the management of HFOV. At our institution, this had led to the earlier use of HFOV and promoted a change in the treatment strategy involving the use of higher frequencies (above 15 Hz) and lower high-frequency tidal volumes (VThf). The purpose of this observational study was to assess how survival without bronchopulmonary dysplasia grades 2 and 3 (SF-BPD) is influenced by these modifications in the respiratory strategy applied to preterm infants (gestational age < 32 weeks at birth) who required mechanical ventilation (MV) in the first 3 days of life. We compared a baseline period (2012-2013) against a period in which this strategy had been fully implemented (2016-2017). A total of 182 patients were exposed to MV in the first 3 days of life being a higher proportion on HFOV at day 3 in the second period 79.5% (n 35) in 2016-2017 vs 55.4% (n 31) in 2012-2013. After adjusting for perinatal risk factors, the second period is associated with an increased rate of SF-BPD (OR 2.28; CI 95% 1.072-4.878); this effect is more evident in neonates born at a gestational age of less than 29 weeks (OR 4.87; 95% CI 1.9-12.48). Conclusions : The early use of HFOV combined with the use of higher frequencies and very low VT was associated with an increase in the study population's SF-BPD. What is Known: • High-frequency ventilation with volume guarantee improve ventilation stability and has been shown to reduce lung damage in animal models. What is New: • The strategy of an earlier use of high-frequency oscillatory ventilation combined with the use of higher frequencies and lower tidal volume is associated to an increase in survival without bronchopulmonary dysplasia in our population of preterm infants. Keywords High-frequencyventilation. Lung protection. Bronchopulmonary dysplasia. Ventilatory-induced lung injury. Target tidal volume. Preterm infants Abbreviations ΔPhf Delta pressure BPD Bronchopulmonary dysplasia type 2-3 BW Birth weight CMV Conventional mechanical ventilation CRIB Critical index for babies DOL Days of life GA Gestational age HFOV High-frequency oscillatory ventilation Hz Hertz INSURE Intubation-surfactant administration-extubation LISA Less-invasive surfactant administration MV Mechanical ventilation nCPAP Nasal continuous airway pressure NEC Necrotizing enterocolitis Communicated by Daniele De Luca

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“…In the past two decades, high-frequency oscillatory ventilation (HFOV) has been used as a rescue therapy for neonates with refractory respiratory failure [1,2]. HFOV is used to recruit compromised lung, improve oxygenation through combined high mean airway pressures (MAPs) and less tidal volumes, and eliminate carbon dioxide with almost no adverse cerebral side effects [3][4][5][6]. Although HFOV is theoretically bene cial for lung protection in preterm infants with severe hypoxemia and hypercapnia [7,8], there are few information regarding how HFOV-treated premature neonates are managed, especially how ventilation settings and adjunctive therapies used before and after use of HFOV would affect the outcomes [9][10][11].…”

Section: Introductionmentioning

confidence: 99%

Therapeutic Effects and Outcomes of Rescue High-Frequency Oscillatory Ventilation for Premature Infants With Severe Refractory Respiratory Failure

Hsu

Yang

Chu

et al. 2020

Preprint

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Background: Despite wide application of high frequency oscillatory ventilation (HFOV) in neonates with respiratory distress, little has been reported about its rescue use in preterm infants. We aimed to evaluate the therapeutic effects of HFOV in preterm neonates with refractory respiratory failure and investigate the independent risk factors of in-hospital mortality.Methods: We retrospectively analyzed data collected prospectively (January 2011-December 2018) in four neonatal intensive care units of two tertiary-level medical centers in Taiwan. All premature infants (gestational age 24-34 weeks) receiving HFOV as rescue therapy for refractory respiratory failure were included.Results: A total of 668 preterm neonates with refractory respiratory failure were enrolled. The median (IQR) gestational age and birth weight were 27.3 (25.3-31.0) weeks and 915.0 (710.0-1380.0) g, respectively. Pre-HFOV use of cardiac inotropic agents and inhaled nitric oxide were 70.5% and 23.4%, respectively. The oxygenation index (OI), FiO2, and AaDO2 were markedly increased after HFOV initiation (all p < 0.001), and can be decreased within 24-48 hours (all p < 0.001) after use of HFOV. 375 (56.1%) patients had a good response to HFOV within 3 days. The final in-hospital mortality rate was 34.7%. No association was found between specific primary pulmonary disease and survival in multivariate analysis. We found preterm neonates with gestational age < 28 weeks, occurrences of sepsis, severe hypotension, multiple organ dysfunctions, initial higher severity of respiratory failure and response to HFOV within the first 72 hours were independently associated with final in-hospital mortality.Conclusions: The mortality rate of preterm neonates with severe respiratory failure remains high after rescue HFOV treatment. Aggressive therapeutic interventions to treat sepsis and prevent organ dysfunctions are the suggested strategies to optimize outcomes.

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High-frequency oscillatory ventilation with volume guarantee: a single-centre experience

Abstract: During HFOV-VG, the tidal volume of oscillations varies in the short term but is maintained very close to the target over the longer term. VThf or DCO have poor correlation with CO levels but a volume of >2.5 mL/kg VThf is rarely needed.

Cited by 19 publications

References 22 publications

Volume Guarantee High-Frequency Oscillatory Ventilation in Preterm Infants With RDS: Tidal Volume and DCO2 Levels for Optimal Ventilation Using Open-Lung Strategies

Volume Guarantee High-Frequency Oscillatory Ventilation in Preterm Infants With RDS: Tidal Volume and DCO2 Levels for Optimal Ventilation Using Open-Lung Strategies

Effect of a new respiratory care bundle on bronchopulmonary dysplasia in preterm neonates

Therapeutic Effects and Outcomes of Rescue High-Frequency Oscillatory Ventilation for Premature Infants With Severe Refractory Respiratory Failure

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