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VIASYS HEALTHCARE INTERNATIONAL. Oslo, November 2006 High Frequency Oscillation. SensorMedics 3100. High Frequency Ventilation Modes:. HFPPV : High Frequency Positive Pressure Ventilation HFFI : High Frequency Flow Interruption HFJV : High Frequency Jet Ventilation

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high frequency ventilation modes
High Frequency Ventilation Modes:
  • HFPPV : High Frequency Positive Pressure Ventilation
  • HFFI : High Frequency Flow Interruption
  • HFJV : High Frequency Jet Ventilation
  • HFOV : High Frequency Oscillating Ventilation
pulmonary injury sequence

Pig model 3 kg with RDS

PCV

PEEP : 7 cm H2O

MAP : 15 cm H2O

PIP : 24 cm H2O

Zoneof

Overdistention

Injury

“Safe”

Window

Volume

Zone of

Derecruitment

and Atelectasis

Injury

Pressure

Pulmonary Injury Sequence
  • There are two injury zones during mechanical ventilation
    • Low Lung Volume Ventilation tears adhesive surfaces
    • High Lung Volume Ventilation over-distends, resulting in “Volutrauma”
  • The difficulty is finding the “Sweet Spot”

Froese AB, Crit Care Med 1997; 25:906

slide5

Sensormedics 3100A HFO Ventilator

2 Principles:

1) Oxygenation (O2) CPAP

2) Ventilation (CO2) Oscillation

principle 1
Principle 1:

CDP

Adjust Valve

ET Tube

Oscillator

Patient

BIAS Flow

Increase Lungvolume with a “super CPAP system”

slide7

Optimized Lung Volume Strategy:

CT Scan :

RDS pig model 3 kg

Continuous Distending Pressure 5 cm H2O

slide8

Optimized Lung Volume Strategy:

CT Scan :

RDS pig model 3 kg

Continuous Distending Pressure 12 cm H2O

slide9

Optimized Lung Volume Strategy:

CT Scan :

RDS pig model 3 kg

Continuous Distending Pressure 20 cm H2O

slide10

CT 2

CT 1

CT 3

  • CDP =
  • Lung Volume

Paw = CDP

Continuous

Distending

Pressure

principle 2

Expiration = ACTIVE No Airtrapping

Disconnection Oxygenation

from Ventilation

Principle 2:

CDP

Adjust Valve

ET Tube

Oscillator

Patient

BIAS Flow

Decrease TV’s to physiological dead space and increase frequency (0.1 – 2ml/Kg)

slide13

+

+

-

-

+

+

Amplitude

CDP/Lung volume

CDP/Lung volume

-

-

optimized lung volume strategy
Optimized Lung Volume Strategy:
    • 2.) Decrease Tidal Volumes to less or equal then dead space
  • and increase frequency !

Benefits: - enhanced gas exchange doe to combined gas

transport mechanisms

- no excessive volume swings

- reduced regional overinflation and stretching

- reduced Volutrauma

gas exchange in hfov
GAS EXCHANGE IN HFOV:

1.)Convection (Bulk Flow) Ventilation

2.) Asymetrical Velocity Profile

3.) Taylor Dispersion

4.) Molecular Diffusion

5.) Pendelluft

6.) Cardiogenic Mixing

suggested reading
SUGGESTED READING :
  • Chang HK. Mechanisms of gas transport during ventilation by HFOV, Brief Review, J Appl Physiol, 1994
  • Schindler M, et al. Effect of Lung Mechanics on Gas Transport During HFO. Pediatric Pulmonology, 1991
pressure transmission cmv hfov
Pressure transmission CMV / HFOV :
  • Distal amplitude measurements with alveolar capsules in animals, demonstrate it to be greatly reduced or “attenuated” as the pressure traverses through the airways.
  • Due to the attenuation of the pressure wave, by the time it reaches the alveolar region, it is reduced down to .1 - 5 cmH2O.

Gerstman et al

airway pressure transmission hfov

I

+

+

+

Amlitude

Delta P =

TV =

Ventilation

+

+

+

CDP

= Lungvolume

= Oxygenation

+

+

+

+

_

_

_

_

_

_

_

_

_

E

Airway Pressure Transmission HFOV :

Pressure

ET Tube

Trachea

Alveolus

Transmission

slide21

CMV Instable Aveoli versus HFOV

Carney et al. Crit Care Med 2005;33:S122-S128

slide23

Dynamic Multiscan CT: Method

airway pressure

CT-acquisition

time

slide25

After lavage,

Step down

slide28

CLINICAL APPLICATIONS

  • Neonatal
    • Prematurity / RDS
    • Surfactant Distribution
    • PPHN
    • Pneumonia's
    • Meconium Aspirations
    • Blood Aspirations
    • Hypoplasias
      • CDH
      • Pulmonary Hypoplasia
    • > 24 hrs. > 40 % FiO2
  • Neonatal Airleaks
    • PIE
    • Pneumothoraces
    • Pneumomediastinum
    • Pneumoperitoneum
pulmonary injury sequence29
Pulmonary Injury Sequence:
  • If we cannot prevent the injury sequence , then the
  • target goal is to interrupt the sequence of events !
  • High Frequency Oscillation does not reverse injury,
  • but will interrupt the progression of injury
3100 a hfov resume
3100 A HFOV Resume:
  • Less Oxygen exposure:
  • Stable lung inflation
  • Recruitment of alveolar space
  • Improved matching V/Q
  • Reduction of Volutrauma:
  • No conventional breaths
  • Less Volume swings
  • No high peak pressures
  • Active Exhalation
  • Reduces Airtrapping
  • Reduces Airway stretch
  • Sufficient Humidification
  • less risk NTB

HFOV

effectively

decouples

Oxygenation

and

Ventilation