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HIGH FREQUENCY VENTILATION

Rene Santin, M.D.


Lungs as a two compartment model
First compartment: AIRWAYS.
Do not participate in gas exchange
referred as anatomic dead space

Second compartment: ALVEOLAR UNITS
responsible for gas exchange
Elements of HFV
Use of supraphysiologic ventilatory
rates above 60 rpm

Use of tidal volume smaller than the
anatomic dead space
Types of HFV
High Frequency Oscillatory Ventilation
High Frequency Jet Ventilation
High Frequency Positive Pressure
Ventilation
Mechanisms of gas transport in High
Frequency Ventilation
Direct alveolar ventilation
Pendelluft effect
Convective streaming
Augmented (Taylor) dispersion
Cardiogenic mixing
Molecular diffusion
Indications for HFV
Neonatal Respiratory Distress Syndrome
Persistent Pulmonary Hypertension
Neonatal Meconium Aspiration Syndrome
Congenital Diaphragmatic Hernia
Neonatal Lung Hypoplasia
Neonatal Air Leak Syndrome with PIE
Pediatric ARDS
RSV Pneumonia (not bronchiolitis!!)
Contraindications for HFV
Obstructive Airway Disease
Asthma, RAD, Emphysema, Bronchiolitis

Cardiovascular System Dysfunction

Shock
Switch from conventional to HFV
Goal of HFV:
maximize oxygenation and ventilation with adequate
lung volume while minimizing barotrauma and
oxygen toxicity.
Indications:
increased FiO2 and Paw with poor saturations. (O2
index)
Initial settings for HFOV
FiO2: 1.0
Mean Airway Pressure: 2-6 cm H2O higher than
conventional ventilation.
Bias flow: 15 L/min
Frequency: 10-15 Hz in neonates, 6-10 Hz in older
patients.
Inspiratory time: 33 %
Power: 2.0-4.0 (amplitude 20-30 cm H2O)
Oxygenation management
Increase MAP until saturations reach >90%
Then, decrease FiO2 progressively down to <
0.60.
If saturations drop below 90% then increase
MAP.
Factors that affect oxygenation in HFV
Main factors:
Mean Airway Pressure (Paw)
FiO2

Circumstantial factors:
Inspiratory time
Frequency (Hz)
Ventilation management
Maintain PaCO2 of 40-50
Maintain pH of >7.30
Permissive hypercarbia: allows for higher
PaCO2 and lower pH
Factors that affect ventilation in HFV
Amplitude pressure (power)
Bias flow
Frequency (Hz)
Inspiratory time
Monitoring the patient on HFV
Frequent observation of chest symmetry
Observation of chest vibration
Evaluation of lung expansion on CXR
Check capillary refill, skin color, temperature.
Comparing central with peripheral pulses
Monitoring of EKG tracing
Care of the patient on HFV
Respiratory care:
suctioning
hand bagging
Chest PT
Patient Positioning
Analgesia, sedation, and neuromuscular blockade
Parent-caretaker interactions

Complications of HFV
Lung Overdistention and Air Leak Syndrome
Cardiovascular depression
Necrotizing Tracheobronchitis
Patient Disconnection
Unplanned Extubation

Switch back to conventional ventilator
HFOV can be weaned gradually to CPAP by
lowering the Amplitude. (in small infants)

Switch to conventional once: (in pediatric pts)
MAP < 15 cm H2O
FiO2< 0.50
adequate gas exchange
improving pulmonary function
Successful switch from HFV to
conventional ventilation
Adequate oxygenation and ventilation
FiO2 <60
rate<30 bpm
PIP < 30 cm H2O
New trends for HFV
HFV and Nitric Oxide
HFOV and Surfactant
HFOV and Partial Liquid Ventilation
HFV in adults
Summary
HFOV, HFJV, HFPPV
Indications
Contraindications
Oxygenation management
Ventilation management
Monitoring and care of the patient
Complications

QUESTIONS?