Not for use in the USA

Babylog 8000 plus

High Frequency Ventilation *
Fully integrated, available at anytime
March 2008, >NAME< * Not available in the USA
 Not for use in the USA
Table of contents

1. What is HFV and how does it work ?

2. Controlling and monitoring of HFV
3. Operating concept Babylog 8000

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 Not for use in the USA
What is high frequency ventilation?

 Frequencies from 5 - 50 Hz (300 - 3.000 / min.)

 Tidal volumes in the range of the dead space volume

 Active in - and expiration

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Typical pressure - time curve
with high frequency oscillation at 12 Hz
Pressure

0 1 seconds

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How can it be generated ?
Working principle of commercial ventilators

 Piston oscillators

 Flow interrupters

 Other devices (loudspeaker principle)

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Working principle
Piston oscillator

Freshgas bias flow

Oscillator

Lowpass
filter

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Working principle
Babylog 8000 plus

Continuous flow
PEEP
Frequency
Amplitude

Venturi Jet Exp. valve

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Types of gas transport

 Direct alveolar ventilation by bulk convection

 Convection by 'high-frequent' pendelluft
 Convective dispersion due to asymmetric velocity profiles
 Taylor-Dispersion
 Molecular diffusion

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 Not for use in the USA
Table of contents

1. What is HFV and how does it work ?

2. Controlling and monitoring of HFV
3. Operating concept Babylog 8000

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 Not for use in the USA
Characteristic parameters
Pressure

FiO2

Amplitude

MAP
PEEP

0 Time

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High frequency ventilation controls
Oxygenation control

PEEP 


MAP  and FiO2 


Oxygenation 

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Relation of
frequency and amplitude
Amplitude

CCircuit 

frequency
 Note: The patient circuit should have the smallest possible compliance
– patient circuit as stiff as possible
– patient circuit as short as possible
– humidifier filled to the maximum water level
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Relation of
mean airway pressure and amplitude

Amplitude 1 < Amplitude 2

Pressure

MAP 2

0 MAP 1

ejector limit

 The negative pressure generated by the ejector is the limiting factor for the
maximal possible amplitude
 By increase of MAP the pressure difference to the ejector pressure is
increased. This allows a bigger amplitude
 If the inspiratory pressure is bigger, then the expiratory pressure
(asymmetric) it will result in airtrapping and intrinsic MAP

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 Not for use in the USA
...how to remember

 Think of a manual car:

– Amplitude = gas

– Tidal volume = speedometer

– Frequency = gear

 If you drive up a steep hill, you have to put your foot down (amplitude 100%)

 If that is not enough:

You need to lower the gear (frequency) to increase speed (Tidal volume)

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High frequency ventilation controls
Ventilation control

 HFV Ventilation control (CO2 removal control)

MAP  frequency 

 
oscillatory amplitude 


oscillatory tidal volume 


pCO2 

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How to monitor?
Pressure and volume at the tip of the ET tube
 Pressure is highly attenuated in the
ET-Tube
P P

 Tidal volume is not attenuated in the

ET-Tube
. .
V V

Ventilator Patient
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How to monitor ?
Volume loss

HF ventilator
volume HF tidal volumes

HF
ventilator
C ET tube

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Babylog 8000 plus
ET-Tube high frequency-pressure attenuation

Pressure in mbar

50

40

30

20

10

0
5 8 10 15 20 Frequency in Hz

Proximal ET-Tube
Distal ET-Tube
Patient circuit:
C = 1,225 mL/mbar
ET tube = 3,5 mm

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Proximal and distal
high frequency tidal volumes

VThf in mL

20

15

10

0
5 8 10 15 20 Frequency in Hz

Proximal ET-Tube
Distal ET-Tube

Patient circuit:
C = 1,225 mL/mbar
ET tube = 3,5 mm

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What is DCO2 ?
paCO2

MV in conventional ventilation
DCO2 = VThf² * f in high frequency ventilation

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VT2 f in lung lavaged rabbits

PaCO2 in torr

120

100

80

60

40

20

0
0 20 40 60 80 100 120 140 DCO2 in mL2bpm

VT²f [mL²/s] with VT = 1 mL/kg

modified from Kamitsuka, et al. Ped. Research (1990) Vol 27, No1, 64 -69

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High frequency ventilation controls
The gas transport coefficient DCO2

 DCO2 = VT2 * f

oscillatory volume  frequency 

 
gas transport coefficient DCO2 


pCO2 

Kamitsuka et al. Ped. Reserach (1990) Vol. 27, No.1, 64-69 Chang. J Appl. Physiol (1984) 56 (3): 553-563

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Table of contents

1. What is HFV and how does it work ?

2. Controlling and monitoring of HFV
3. Operating concept Babylog 8000

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Starting High Frequency Ventilation

 Press Vent.
Option

 Select

 Set frequency and amplitude

by or

 Press

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Pure HFV or mixed with IMV strokes?
Combination of HFV and CMV / IMV

 For intermediate recruitments High

Frequency Ventilation can be added to
expiration phases of CMV / IMV

 With HfVol the minute volume and

the tidal volume of the IMV strokes
can be monitored

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Secretolysis

 High resistance decreases the

effectiveness of HFV

 The ‘Minute Volume low’ alarm indicates

that suctioning may be required

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Thank you for

your attention.