1 Elsevier items and derived items © 2010 by Saunders, an imprint of Elsevier Inc. Chapter 20 Neonatal and Pediatric High-Frequency Ventilation

2 Elsevier items and derived items © 2010 by Saunders, an imprint of Elsevier Inc. High-Frequency Ventilation  HFV is defined as mechanical ventilation using tidal volumes less than or equal to dead space delivered at supraphysiologic rates

3 Elsevier items and derived items © 2010 by Saunders, an imprint of Elsevier Inc. High-Frequency Ventilation (cont.)

4 Elsevier items and derived items © 2010 by Saunders, an imprint of Elsevier Inc. Ventilation  (VCO 2 ) = (f) x ´ (V T ) y  ET Tube diameter  Lung compliance  Ventilator frequency..

5 Elsevier items and derived items © 2010 by Saunders, an imprint of Elsevier Inc. Ventilation (cont.)

6 Elsevier items and derived items © 2010 by Saunders, an imprint of Elsevier Inc. Oxygenation

7 Oxygenation (cont.)

8 Elsevier items and derived items © 2010 by Saunders, an imprint of Elsevier Inc. Indications  Neonates  Diffuse, homogeneous lung disease  Existing pulmonary air leak syndromes  Pediatrics  Acute RDS  Pulmonary air leak

9 Elsevier items and derived items © 2010 by Saunders, an imprint of Elsevier Inc. Ventilator Settings  Frequency  Oscillatory amplitude or peak pressure  Positive end expiratory pressure  Fraction of inspired oxygen

10 Elsevier items and derived items © 2010 by Saunders, an imprint of Elsevier Inc. Ventilator Settings (cont.)  Mean airway pressure or continual distending pressure  Flow  Inspiratory time

11 Elsevier items and derived items © 2010 by Saunders, an imprint of Elsevier Inc. Bunnell Life Pulse Jet Ventilator

12 Elsevier items and derived items © 2010 by Saunders, an imprint of Elsevier Inc. Hi-Lo Jet Endotracheal Tube

13 Elsevier items and derived items © 2010 by Saunders, an imprint of Elsevier Inc. SensorMedics 3100A/3100B HFOV

14 Elsevier items and derived items © 2010 by Saunders, an imprint of Elsevier Inc. Circuit Considerations  Very low circuit compliance  Intrinsic timing mechanisms  Control over inspiratory times  Sufficient time for gas egress  Adequately humidify gases  Alarms and fail-safe devices

15 Elsevier items and derived items © 2010 by Saunders, an imprint of Elsevier Inc. Ventilator Management  Initial management  Proper gas temperature and humidity  Ventilator and circuit position  Initial settings are lower than anticipated  Appropriate primary therapies

16 Elsevier items and derived items © 2010 by Saunders, an imprint of Elsevier Inc. Clinical Management Strategies  High-volume strategy  Optimize lung inflation  Minimize ventilation-perfusion

17 Elsevier items and derived items © 2010 by Saunders, an imprint of Elsevier Inc. High-Volume Strategy

18 Elsevier items and derived items © 2010 by Saunders, an imprint of Elsevier Inc. Sustained Inflations  Applying plateau pressures at levels in excess of expected alveolar opening pressures for periods of 5 to 30 seconds

19 Elsevier items and derived items © 2010 by Saunders, an imprint of Elsevier Inc. Clinical Management Strategies  Low volume  Allows the lung to slowly deflate or minimizes ongoing air leakage  Provides tolerable ventilation while accepting a higher FIO 2

20 Elsevier items and derived items © 2010 by Saunders, an imprint of Elsevier Inc. Weaning  Minute ventilation  HFFI and HFOV Reducing oscillatory amplitude during Reducing oscillatory amplitude during  HFJV Decreasing peak pressure and on time Decreasing peak pressure and on time  mPaw  Radiographic assessment of lung volume  FIO 2

21 Elsevier items and derived items © 2010 by Saunders, an imprint of Elsevier Inc. Care of the Patient  Positioning  Endotracheal tube  Suctioning  Monitoring

22 Elsevier items and derived items © 2010 by Saunders, an imprint of Elsevier Inc. Troubleshooting  Chest wall movement  Cardiac output  Pathology  Specific for equipment

23 Elsevier items and derived items © 2010 by Saunders, an imprint of Elsevier Inc. Emerging Clinical Application  Surfactant replacement  Inhaled nitric oxide  Liquid ventilation