In vitro performance comparison of the Sensormedics 3100A and B high-frequency oscillatory ventilators

Custer, Jason W.; Ahmed, Andaleeb A.; Kaczka, David W.; Mulreany, Daniel G.; Hager, David N.; Simon, Brett A.; Easley, R. Blaine

doi:10.1097/pcc.0b013e3181fe3028

Cited by 7 publications

(9 citation statements)

References 16 publications

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“…Consequently, we cannot comment on the effect of device and parameter selection on potential for lung injury, or clinically appreciable differences in CO 2 removal during clinical application. However, our study shows clearly, like others previously [8,9,10,14,19], that ventilator-displayed settings are not directly transferable between devices due to differences in oscillator performance. Understanding the behaviour of each ventilator remains paramount to its optimal use and application, especially given the wide range of oscillators available.…”

Section: Discussioncontrasting

confidence: 39%

“…The differences in ΔP TRACH and V T between devices within the permutations tested, particularly I:E ratio, were important and consistent with observations in older devices [8,9,10,18,19]. Oscillators could be considered as having a frequency-dependent plateau or not.…”

Section: Discussionmentioning

confidence: 66%

“…This was intentional as humidifiers vary between oscillators, humidification provides a variable that is difficult to standardise and the mechanical test lung is not designed to be humidified, potentially influencing the fidelity of the pressure and flow measurements. Apart from the recent report of Grazioli et al [13], in which a dry humidification chamber was left in situ, all previous in vitro reports of HFOV performance have not reported whether the chamber was present [8,10,19]. …”

Section: Discussionmentioning

confidence: 99%

“…Although similar recent reports have also used the Michigan test lung [12,13,14,19], an alternative rigid test lung model was used in earlier in vitro assessments [8,10]. This model permits the use of the adiabatic gas equation to derive flow and volume and has potential advantages, including allowing humidification, permitting lower C L values and obviating the need for an additional flow sensor with its inherent influence on resistance.…”

Section: Discussionmentioning

confidence: 99%

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Are All Oscillators Created Equal? In vitro Performance Characteristics of Eight High-Frequency Oscillatory Ventilators

Tingay

John²,

Harcourt

et al. 2015

Neonatology

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Background: The mode of waveform generation and circuit characteristics differ between high-frequency oscillators. It is unknown if this influences performance. Objectives: To describe the relationships between set and delivered pressure amplitude (ΔP), and the interaction with frequency and endotracheal tube (ETT) diameter, in eight high-frequency oscillators. Methods: Oscillators were evaluated using a 70-ml test lung at 1.0 and 2.0 ml/cm H₂O compliance, with mean airway pressures (P_AW) of 10 and 20 cm H₂O, frequencies of 5, 10 and 15 Hz, and an ETT diameter of 2.5 and 3.5 mm. At each permutation of P_AW, frequency and ETT, the set ΔP was sequentially increased from 15 to 50 cm H₂O, or from 20 to 100% maximum amplitude (10% increments) depending on the oscillator design. The ΔP at the ventilator (ΔP_VENT), airway opening (ΔP_AO) and within the test lung (ΔP_TRACH), and tidal volume (V_T) at the airway opening were determined at each set ΔP. Results: In two oscillators the relationships between set and delivered ΔP were non-linear, with a plateau in ΔP thresholds noted at all frequencies (Dräger Babylog 8000) or ≥10 Hz (Dräger VN500). In all other devices there was a linear relationship between ΔP_VENT, ΔP_AO and ΔP_TRACH (all r² >0.93), with differing attenuation of the pressure wave. Delivered V_T at the different settings tested varied between devices, with some unable to deliver V_T >3 ml at 15 Hz, and others generating V_T >20 ml at 5 Hz and a 1:1 inspiratory-to-expiratory time ratio. Conclusions: Clinicians should be aware that modern high-frequency oscillators exhibit important differences in the delivered ΔP and V_T.

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Section: Discussioncontrasting

confidence: 39%

Section: Discussionmentioning

confidence: 66%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Are All Oscillators Created Equal? In vitro Performance Characteristics of Eight High-Frequency Oscillatory Ventilators

Tingay

John²,

Harcourt

et al. 2015

Neonatology

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“…Second, collapsed lung regions are more easily opened at higher f. 72 Third, the delivered V T is more equally distributed, as it becomes less dependent on regional compliance at higher f. 73 Lastly, the square block waveform is better preserved, allowing a more constant V T . 74,75 Needless to say, it is necessary to maintain an appropriate CDP when setting the f.…”

Section: Best Hfov Approach and Oscillator Settings For Ventilationmentioning

confidence: 99%

Reflections on Pediatric High-Frequency Oscillatory Ventilation From a Physiologic Perspective

2012

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Mechanical ventilation using low tidal volumes has become universally accepted to prevent ventilator-induced lung injury. High-frequency oscillatory ventilation (HFOV) allows pulmonary gas exchange using very small tidal volume (1-2 mL/kg) with concomitant decreased risk of atelectrauma. However, its use in pediatric critical care varies between only 3% and 30% of all ventilated children. This might be explained by the fact that the beneficial effect of HFOV on patient outcome has not been ascertained. Alternatively, in contrast with present recommendations, one can ask if HFOV has been employed in its most optimal fashion related especially to the indications for and timing of HFOV, as well as to using the best oscillator settings. The first was addressed in one small randomized study showing that early use of HFOV, instead of rescue use, was associated with improved survival. From a physiologic perspective, the oscillator settings could be refined. Lung volume is the main determinant of oxygenation in diffuse alveolar disease, suggesting using an open-lung strategy by recruitment maneuvers, although this is in practice not custom. Using such an approach, the patient can be oscillated on the deflation limb of the pressurevolume (P-V) curve, allowing less pressure required to maintain a certain amount of lung volume. Gas exchange is determined by the frequency and the oscillatory power setting, controlling the magnitude of the membrane displacement. Experimental work as well as preliminary human data have shown that it is possible to achieve the smallest tidal volume with concomitant adequate gas exchange when oscillating at high frequency and high fixed power setting. Future studies are needed to validate these novel approaches and to evaluate their effect on patient outcome.

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High Frequency Oscillatory Ventilation

Ventre

Arnold

2014

Pediatric Critical Care Medicine

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Forty years have elapsed since investigators fi rst appreciated that tidal volumes measuring less than the physiologic dead space can produce reliable ventilation when delivered at high frequencies. Of all high frequency ventilation techniques, high frequency oscillatory ventilation (HFOV) is the most well studied and is the most commonly utilized in clinical practice today. In HFOV, small volume oscillatory vibrations are superimposed on continuous distending pressure in a manner that allows effi cient CO 2 elimination during continuous alveolar recruitment. By preserving end-expiratory lung volume, minimizing cyclic stretch, and avoiding alveolar overdistension at end-inspiration, HFOV is uniquely capable of providing the ultimate "open lung" strategy of ventilation. Over the past decade, a growing evidence base implicating phasic alveolar stretch in the pathogenesis of acute and chronic lung injury in patients with respiratory failure has driven the iterative refi nement of HFOV management protocols for infants, children, and adults. The next step toward applying HFOV in a manner that takes into account the heterogeneity of parenchymal involvement in diseases such as the acute respiratory distress syndrome will require the development of non-invasive bedside technologies capable of identifying regional changes in lung volume and lung mechanics. Electrical impedance tomography (EIT) is a promising technique that could play a supporting role in the conduct of future clinical trials seeking to identify HFOV strategies that are maximally lung protective.

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In vitro performance comparison of the Sensormedics 3100A and B high-frequency oscillatory ventilators

Cited by 7 publications

References 16 publications

Are All Oscillators Created Equal? In vitro Performance Characteristics of Eight High-Frequency Oscillatory Ventilators

Are All Oscillators Created Equal? In vitro Performance Characteristics of Eight High-Frequency Oscillatory Ventilators

Reflections on Pediatric High-Frequency Oscillatory Ventilation From a Physiologic Perspective

High Frequency Oscillatory Ventilation

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