Respiratory mechanics during high-frequency oscillatory ventilation: a physical model and preterm infant study

Singh, Rachana; Courtney, Sherry E.; Weisner, Michael D.; Habib, Robert H.

doi:10.1152/japplphysiol.01120.2011

Cited by 15 publications

(13 citation statements)

References 26 publications

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“…However, leaks around the tube may reduce the effective distending pressure and lung-delivered oscillation volumes (76), for which the operator may need to compensate by increasing the mean airway pressure and amplitude settings. However, leaks around the tube may reduce the effective distending pressure and lung-delivered oscillation volumes (76), for which the operator may need to compensate by increasing the mean airway pressure and amplitude settings.…”

Section: S57mentioning

confidence: 99%

Ventilatory Support in Children With Pediatric Acute Respiratory Distress Syndrome

Rimensberger

Cheifetz

2015

Pediatric Critical Care Medicine

125

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The Consensus Conference developed pediatric-specific recommendations regarding mechanical ventilation of the patient with pediatric acute respiratory distress syndrome as well as future research priorities. These recommendations are intended to initiate discussion regarding optimal mechanical ventilation management for children with pediatric acute respiratory distress syndrome and identify areas of controversy requiring further investigation.

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Section: S57mentioning

confidence: 99%

Ventilatory Support in Children With Pediatric Acute Respiratory Distress Syndrome

Rimensberger

Cheifetz

2015

Pediatric Critical Care Medicine

125

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“…15 HFOV application enables a consistently sufficient end-expiratory volume without inducing the overdistension or collapse of alveoli due to the much smaller tidal volumes. 16 Rapid piston oscillations drive gas transport and active inspiration and expiration. Higher mPaw values and lower tidal volumes prevent alveolar derecruitment and overdistension respectively, thereby maintaining alveolar stability.…”

Section: Critical Care Medicinementioning

confidence: 99%

Higher Frequency Ventilation Attenuates Lung Injury during High-frequency Oscillatory Ventilation in Sheep Models of Acute Respiratory Distress Syndrome

et al. 2013

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Background: High-frequency oscillatory ventilation (HFOV) at higher frequencies minimizes the tidal volume. However, whether increased frequencies during HFOV can reduce ventilator-induced lung injury remains unknown. Methods: After the induction of acute respiratory distress syndrome in the model by repeated lavages, 24 adult sheep were randomly divided into four groups (n = 6): three HFOV groups (3, 6, and 9 Hz) and one conventional mechanical ventilation (CMV) group. Standard lung recruitments were performed in all groups until optimal alveolar recruitment was reached. After lung recruitment, the optimal mean airway pressure or positive end-expiratory pressure was determined with decremental pressure titration, 2 cm H 2 O every 10 min. Animals were ventilated for 4 h. Results: After lung recruitment, sustained improvements in gas exchange and compliance were observed in all groups. Compared with the HFOV-3 Hz and CMV groups, the transpulmonary pressure and tidal volumes were statistically significantly lower in the HFOV-9 Hz group. The lung injury scores and wet/dry weight ratios were significantly reduced in the HFOV-9 Hz group compared with the HFOV-3 Hz and CMV groups. Expression of interleukin-1β and interleukin-6 in the lung tissue, decreased significantly in the HFOV-9 Hz group compared with the HFOV-3 Hz and CMV groups. Malondialdehyde expression and myeloperoxidase activity in lung tissues in the HFOV-9 Hz group decreased significantly, compared with the HFOV-3 Hz and CMV groups. Conclusion: The use of HFOV at 9 Hz minimizes lung stress and tidal volumes, resulting in less lung injury and reduced levels of inflammatory mediators compared with the HFOV-3 Hz and CMV conditions. A CUTE respiratory distress syndrome (ARDS) is the most severe manifestation of acute lung injury caused by various direct and indirect factors. Inflammatory pulmonary edema, severe hypoxemia, and diffuse endothelial and epithelial injury are key characteristics of ARDS, which can often lead to multiple organ failure.1,2 Despite being the most widely used approach to treat ARDS, conventional mechanical ventilation (CMV) can induce ventilatorinduced lung injury (VILI) due to alveolar overdistension and the cyclic collapse/reopening of lung units, eliciting inflammatory responses, and worsening the damage. 3,4 Recently, protective CMV has been shown to decrease lung and systemic inflammatory responses and improve What We Already Know about This Topic• High-frequency oscillatory ventilation provides efficient gas exchange using very high frequencies and low tidal volumes, while maintaining a constant mean airway pressure • The effects of frequency in high-frequency oscillatory ventilation on ventilation-induced lung injury are yet to be evaluated What This Article Tells Us That Is New• This study suggests that high-frequency oscillatory ventilation at higher frequencies minimizes lung stress and tidal volume, resulting in less lung injury and reduced local lung inflammation

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“…CO 2 excretion during HFOV is defined by the diffusion coefficient of CO2 (DCO 2 ) as an indicator of alveolar ventilation. Since DCO 2 (ml 2 /s) is formulated by "DCO 2 =f x VThf 2 ", even small changes in VThf affect DCO 2 more than changes in frequency (10)(11)(12). DCO 2 has been considered an important parameter in the follow-up of CO 2 elimination, however, its value providing normocapnia varies from patient to patient.…”

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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Respiratory mechanics during high-frequency oscillatory ventilation: a physical model and preterm infant study

Cited by 15 publications

References 26 publications

Ventilatory Support in Children With Pediatric Acute Respiratory Distress Syndrome

Ventilatory Support in Children With Pediatric Acute Respiratory Distress Syndrome

Higher Frequency Ventilation Attenuates Lung Injury during High-frequency Oscillatory Ventilation in Sheep Models of Acute Respiratory Distress Syndrome

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

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