Treatment of RDS by high-frequency oscillatory ventilation: A preliminary report

Marchak, B. Elaine; Thompson, W. K.; Duffty, P; Miyaki, T.; Bryan, M. H.; Bryan, A. C.; Froese, A. B.

doi:10.1016/s0022-3476(81)80480-5

Cited by 152 publications

(53 citation statements)

References 12 publications

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“…BMO-20N) at a bias flow of 5 liter/min and an oxygen concentration of 2 1 to 25%. Random combinations of Paw of 4, 8, 12, and 16 cm H 2 0 and frequencies of 3,6,12,16, and 20 Hz were used. At each frequency, the volume generated by the oscillator was adjusted to produce a constant ventilator generated minute ventilation although the actual volume delivered to the ancmal was not controlled or measured.…”

Section: Methodsmentioning

confidence: 99%

“…Because HFOV may enable adequate gas exchange to occur at reduced pressure swings, it may alleviate some of the complications of assisted ventilation, However, oxygenation during HFOV is largely dependent on Paw (3,4). Inasmuch as increasing Paw has been shown to depress CO (5-7), oxygen transport may be reduced despite an increase in arterial oxygenation.…”

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confidence: 99%

“…The occurrence of cardiac depression during assisted ventilation is not a common clinical problem in infants with respiratory distress syndrome (1,3). This has been attributed to the decreased lung compliance that causes a reduction in the transmission of airway pressure to the intrathoracic structures.…”

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confidence: 99%

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Impairment of Hemodynamics with Increasing Mean Airway Pressure during High-Frequency Oscillatory Ventilation

et al. 1988

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ABSTRACT. We investigated the effects of changes in mean airway pressure (Paw), oscillatory frequency and lung compliance on cardiac output (CO) and pulmonary vascular resistance in seven adult cats (3.0 f 0.6 kg) during highfrequency oscillatory ventilation (HFOV). The cats were anesthetized with chloralose and urethane and ventilated with a high-frequency oscillator at Paw of 4,8,12, and 16 cm H,O and frequencies of 3,6, 12,16, and 20 Hz. Saline lavage was used to reduce lung compliance. CO was continuously recorded with an electromagnetic flow probe placed around the aorta and pulmonary vascular resistance was calculated from left atrial and pulmonary artery pressures. Lung lavage reduced static compliance of the respiratory system but did not change CO during pressurelimited ventilation. During HFOV, CO was higher in animals after lung lavage at each Haw. As Haw was raised from 4 to 16 cm H,O during HFOV, CO decreased from 133 f 36 to 87 f 31 ml/min kg in animals with normal lungs and decreased from 153 f 33 to 107 f 19 ml/min kg after lung lavage (both p < 0.001). Increasing Haw was also associated with an increase in pulmonary vascular resistance both before and after lung lavage (both p < 0.005). Changes in frequency did not significantly alter CO or pulmonary vascular resistance. We conclude that the interaction between t h e heart and lungs during HFOV is largely mediated by Paw and compliance of the respiratory system. Furthermore, regardless of the degree of lung compliance, cardiac function may be impaired during HFOV as Paw is elevated. (Pediatr Res 23:628-631,1988) Abbreviations CO, cardiac output HFOV, high-frequency oscillatory ventilation -Paw, mean airway pressure PVR, pulmonary vascular resistance Assisted ventilation has substantially reduced mortality in infants with respiratory failure. Unfortunately this reduced mortality has been accompanied by an increase in major complications such as air leaks and bronchopulmonary dysplasia. Inasmuch as these side effects are heavily influenced by certain Received November 30, 1987; accepted February 10, 1988 ventilatory parameters, especially airway pressures (1, 2), new ventilators that enhance gas exchange while minimizing pressure delivery have been developed.HFOV, delivers and withdraws small stroke volumes at very high frequencies. Because HFOV may enable adequate gas exchange to occur at reduced pressure swings, it may alleviate some of the complications of assisted ventilation, However, oxygenation during HFOV is largely dependent on Paw (3,4). Inasmuch as increasing Paw has been shown to depress CO (5-7), oxygen transport may be reduced despite an increase in arterial oxygenation.Because the effect of Faw on cardiovascular function is dependent on the transpulmonary pressure, decreased lung compliance is thought to be associated with less impairment of CO. However, CO is difficult to assess in small infants and often blood pressure and heart rate are the only available means of assessing cardiovascular function. As a result, it remains un...

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Section: Methodsmentioning

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Impairment of Hemodynamics with Increasing Mean Airway Pressure during High-Frequency Oscillatory Ventilation

et al. 1988

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“…HMD, hyaline membrane disease Pa/A 02, arterial to alveolar oxygen ratio HFV, high frequency, low volume ventilation FawOz, FawC02, I:E, inspiratory:expiratory ratio ANOVA, analysis of variance PIE, pulmonary interstitial emphysema HFV has been proposed as an alternative to conventional PPV/PEEP in the management of infants with HMD (1)(2)(3)(4). Interest in this technique has been generated by the observation that, with an appropriate strategy, HFV can accomplish gas exchange at lower intrapulmonary intraluminal distending pressures, thus potentially reducing the risk of baroinjury (5)(6)(7)(8).…”

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Ventilatory Management of Infant Baboons with Hyaline Membrane Disease: The Use of High Frequency Ventilation1

et al. 1987

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ABSTRAm. We tested the hypothesis that high frequency oscillatory ventilation (HFOV) would result in decreased pulmonary barotrauma in infants with hyaline membrane disease by comparing HFOV at 10 Hz to conventional positive pressure ventilation with continual distending airway pressure (PPV/PEEP) in premature baboons with hyaline membrane disease. Nineteen baboon fetuses were randomized to one of two treatment groups, delivered at 140 * 2 days, and, after stabilization and instrumentation of PPVIPEEP, placed in their respective ventilator group. Animals on conventional ventilation were managed by adjustment of tidal volume and frequency (to 1 Hz) to keep PaCOz below 55 and by adjustment of the mean airway pressure. One of the "HFOV" group died of cardiovascular complications before going on HFOV and was eliminated from data analysis. The remaining HFOV baboons survived the 11-day experimental period without evidence of airleak. Six of the 11 prematures treated with PPV/PEEP developed pulmonary interstitial emphysema and/or pneumothorax and five of the animals died within 48 h. The intergroup differences in airleak were significant (p < 0.05). Mean airway pressure (measured at the proximal airway) was higher initially with HFOV but then was lowered more rapidly than in the PPVIPEEP animals. The arterial to alveolar oxygen ratio rose and the FIOZ could be lowered more rapidly with HFOV than with conventional ventilation. These differences reached significance by 20 h. After 60 h there were no significant differences between HFOV and the PPVIPEEP survivors. HFOV resulted in more uniform saccular expansion, higher arterial to alveolar oxygen ratio, less oxygen exposure, and decreased acute barotrauma when compared to PPV/ PEEP. Although initially mean airway pressure was in the HFOV animals this was not associated with measurable baroinjury. These data support the efficacy of HFOV in the treatment of prematures with hyaline membrane disease. (Pediatr Res 21: 594-602, 1987) Abbreviations HFOV, high frequency oscillatory ventilation -Paw, mean airway pressure HMD, hyaline membrane disease Pa/A 02, arterial to alveolar oxygen ratio HFV, high frequency, low volume ventilation FawOz, FawC02, I:E, inspiratory:expiratory ratio ANOVA, analysis of variance PIE, pulmonary interstitial emphysema HFV has been proposed as an alternative to conventional PPV/PEEP in the management of infants with HMD (1-4). Interest in this technique has been generated by the observation that, with an appropriate strategy, HFV can accomplish gas exchange at lower intrapulmonary intraluminal distending pressures, thus potentially reducing the risk of baroinjury (5-8).The mechanisms of lung injury in infants with HMD are incompletely understood. Although most investigators believe that pulmonary immaturity, baroinjury, oxygen toxicity, and infection play a role in the pathogenesis of bronchopulmonary dysplasia, there is no general agreement about the relative importance of each factor (9-1 3). The premature baboon, delivered at 140 days gestatio...

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“…These results suggest that using the high frequency ventilator tested, to minimize alveolar barotrauma one should choose the highest frequency where gas exchange is adequate. (Pediatr Res 19: 162-166,1985) Abbreviations HFV, high frequency-low tidal volume ventilation HFV is currently under investigation as a new technique for treatment of adults and infants with respiratory failure (2,3,6,8,10,15). Its major advantage is the potential for adequate gas exchange with lower dynamic pressures within the airways.…”

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Alveolar Pressure Swings during High Frequency Ventilation in Rabbits

Frantz

1985

Pediatr Res

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ABSTRAm. In order to understand the pressures and volumes delivered during ventilation with the Emerson flow-interrupting high frequency ventilator, we have measured dynamic and mean pressures at the airway opening, trachea, and alveoli as well as delivered volumes in vivo in closed-chest adult rabbits ventilated at rates of 2-37.5 Hz. To measure alveolar pressure we opened the chest, glued an alveolak capsule to the visceral pleural surface, punctured the pleura and lung surface through the capsule, inserted a pressure transducer into the capsule and closed the chest. We measured delivered volume with a pressure plethysmograph. Alveolar pressure swings fell with increasing frequency, as did delivered volume. Alveolar pressure swings were always lower than those at the airway opening or in the trachea. Removal of the rib cage resulted in a decrease in alveolar pressure swings although muscle paralysis had little effect. Mean pressures were equal at the airway opening, trachea, and alveoli at all frequencies. These results suggest that using the high frequency ventilator tested, to minimize alveolar barotrauma one should choose the highest frequency where gas exchange is adequate. (Pediatr Res 19: 162-166,1985) Abbreviations HFV, high frequency-low tidal volume ventilation HFV is currently under investigation as a new technique for treatment of adults and infants with respiratory failure (2,3,6,8,10,15). Its major advantage is the potential for adequate gas exchange with lower dynamic pressures within the airways. While there is evidence that dynamic pressure in the trachea may be lower during HFV than during conventional ventilation (6), data from our laboratory demonstrate that under conditions of low oscillatory flow and pressure amplitudes, alveolar pressure swings may exceed those at the airway opening near the resonant frequency of the respiratory system (1, 7). Although these data provide important physiologic information, they do not have direct clinical relevance since the experiments were camed out using dynamic pressures at the airway opening which were very much lower than those used for HFV. Furthermore, excised lungs were studied, eliminating effects of the chest wall. The objectives of this study were to measure dynamic pressure within the alveoli in vivo in response to pressure oscillations generated

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Treatment of RDS by high-frequency oscillatory ventilation: A preliminary report

Cited by 152 publications

References 12 publications

Impairment of Hemodynamics with Increasing Mean Airway Pressure during High-Frequency Oscillatory Ventilation

Impairment of Hemodynamics with Increasing Mean Airway Pressure during High-Frequency Oscillatory Ventilation

Ventilatory Management of Infant Baboons with Hyaline Membrane Disease: The Use of High Frequency Ventilation1

Alveolar Pressure Swings during High Frequency Ventilation in Rabbits

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