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High Frequency Ventilation
High Frequency Ventilation
Flow
infants weighing more than 2,000 g.
20L/min
infants less than 2,000g
10 to 15 L/min should be adequate.
Power
The power setting determines the amplitude of oscillation (P) and
thus the tidal volume and degree of ventilation.
In HFOV, the tidal volume produced by the power setting is less than
the deadspace volume.
The CO2 is drawn out actively during oscillation. Initially, the power
setting should be increased in increments of 2 to 4 cm H2O unless
the PCO2 demands require dynamic changes for increasing or
decreasing the amplitude.
Changes in the power setting will affect the mPaw, thus requiring
readjustment of the mPaw.
The piston should be centered continuously when changes are made.
Frequency
The initial frequency setting is 8 to 15 Hz depending on
the size of the infant and the diagnosis.
The frequency may need adjustment when changes
are made to amplitude or mPaw.
The piston should be centered continuously when
changes are made. Increasing the power (amplitude of
oscillation or P) or decreasing the frequency (Hz)
increase delivered tidal volume and decrease PaCO2.
Inspiratory time %
The inspiratory time % determines the I:E ratio and is
usually set at 33%.
This setting provides an I:E ratio of 1:2.
This parameter is not routinely changed.
FiO2
The initial FIO2 may be set at 100%.
After stabilization of the patient, the FIO2 is titrated to
keep SpO2 between 90% and 95%.
A study conducted by Peter et. al., entitled High-
frequency oscillatory ventilation for adult respiratory
distress syndrome states that High-frequency
oscillatory ventilation is both safe and effective in
adult patients with severe ARDS failing conventional
ventilation. A lung volume recruitment strategy during
high-frequency oscillatory ventilation produced
improved gas exchange without a compromise in
oxygen delivery. These results are encouraging and
support the need for a prospective, randomized trial
of algorithm-controlled conventional ventilation vs.
high-frequency oscillatory ventilation for adults with
severe ARDS. (Crit Care Med 1997; 25:937-947)
Randomized study of high-frequency oscillatory ventilation in
infants with severe respiratory distress syndrome