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High-Frequency Ventilation
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High-Frequency Ventilation - 1

High-Frequency Ventilation -Basics and Practical Applications Rainer Stachow Drager. Technology for Life

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High-Frequency Ventilation - 2

Important note: Medical knowledge is subject to constant change due to research and clinical experience. The author of this booklet has taken great care to make certain that the views, opinions and assertions included, particularly those concerning applications and effects, correspond with the current state of knowledge. However, this does not absolve readers from their obligation to take clinical measures on their own responsibility. All rights to this booklet are reserved by Dr. R. Stachow and Dragerwerk AG, in particular the right of reproduction and distribution. No part of this booklet...

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High-Frequency Ventilation - 3

High-Frequency Ventilation Basics and Practical Application Dr. Rainer Stachow, Allgemeines Krankenhaus Heidberg, Hamburg

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High-Frequency Ventilation - 5

High-frequency ventilation (HFV) as a ventilatory therapy has reach­ d e increasing clinical application over the past ten years. The term comprises several methods. High-frequency jet ventilation must be diffe­ rentiated from high-frequency oscillatory ventilation (HFOV or HFO). In this booklet I concentrate on high-frequency oscillatory ventilation. Therefore, the difference in meaning notwithstanding, I use both acronyms, HFV and HFO, interchangeably. Several devices are commercially available at present. They differ not­ ably in technology, performance, versatility, user-friendliness,...

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2.1 Augmented longitudinal gas transport 2.4. Effect on respiratory mechanics and haemodynamics 13 3 Characteristic parameters and control variables of HFV 14 3.1 Mean airway pressure (MAP) 14 3.4 The coefficient of gas transport DCO2 19 6.1 Transition from conventional ventilation 24 6.4 Weaning from oscillatory ventilation 27 8 Strategies for various lung diseases 31 8.1 HFV for diffuse homogeneous lung diseases 31 8.2 HFV for inhomogeneous lung diseases 32 8.5 HFV for pulmonary hypertension of the newborn

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12.1 The high-frequency mode of the Babylog 8000 41 12.1.1 Adjusting HFO with the Babylog 8000 46 12.1.2 Oscillatory volume, frequency and MAP with the Babylog 8000 49 12.1.3 Amplitude setting and oscillatory volume 51

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Commercial ventilators, Effects 1.1 Introduction In the era of surfactant there are still some neonates who cannot be adequately ventilated with even sophisticated conventional v ­ entilation. Therefore respiratory insufficiency remains one of the major causes of neonatal mortality. Intensification of conventional ventilation with higher rates and airway pressures leads to an increased incidence of barotrauma. Especially the high shearing forces resulting from large pressure amplitudes damage lung ­issue. Either t ECMO or high-frequency oscillatory ventilation might resolve such desperate...

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Commercial ventilators, Effects 1.3 Commercial ventilators Various technical principles are used to generate oscillating ­ ent­ v ilation patterns. The so-called „true“ oscillators provide active inspira­ tion and active expiration with sinusoidal waveforms: – piston oscillators (e.g. Stefan SHF 3000, Hummingbird V, Dufour OHF1) move a column of gas rapidly back and forth in the brea­ thing circuit with a piston pump. Its size determines the stroke volume, which is therefore fairly constant. A bias flow system supplies fresh gas (figure 1.2). – Other devices (e.g. Sensormedics 3100A)...

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Commercial ventilators, Effects – The InfantStar interrupts the inspiratory gas flow with a valve bank. Some authors regard this device as a jet ventilator because of its principle of operation [83, 41]. – The Babylog 8000 delivers a high inspiratory continuous flow (max 30 l/min) and generates oscillations by rapidly switching the expira­ tory valve. Active expiration is provided with a jet ­ enturi system. V 1) The Stefan SHF 3000 is the registered trademark of F. Stefan GmbH, Gackenbach, Germany; The Hummingbird V is registered trademark of Metran Medical Instr. MfG Co., Ltd., Japan; The...

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Commercial ventilators, Effects 2 Effects of high-frequent oscillations The efficacy of HFV is primarily due to improvement in pulmonary gas exchange. Yet it can also have favourable influence on respirat­ ry o mechanics and haemodynamics. During conventional ventilation direct alveolar ventilation accompli­ shes pulmonary gas exchange. According to the classic concept of pulmonary ventilation the amount of gas reaching the alveoli equals the applied tidal volume minus the deadspace volume. At tidal volumes below the size of the anatomical deadspace this model fails to explain gas exchange....

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High-Frequency Ventilation - 12

Commercial ventilators, Effects 2.1. Augmented longitudinal gas transport and enhanced d ­ ispersion A number of those mechanisms are derived from the fundamental dispersion process discovered by Taylor in 1953. In this process an initially plane boundary surface between two gases develops into a pike-shaped profile as the velocity of one of the gases increases (figure 2.1). The resulting longitudinal gas transport is much higher than through molecular diffusion alone. In addition, the gases mix by lateral diffusion. The higher the molecular diffusivity the less the boundary surface between...

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Commercial ventilators, Effects Pulsation of bronchial walls can reverse gas flow and thereby increase the concentration gradient between the two gases. This causes additional longitudinal gas movement. 2.2 Direct alveolar ventilation A small part of proximal alveoli is still ventilated directly. Here, gas exchange takes place as in conventional ventilation. 2.3 Intraalveolar pendelluft Not all regions of the lung have the same compliance and r ­ esistance. Therefore, neighbouring units with different time constants are ventilated out of phase, filling and emptying at different rates. Due...

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Characteristic parameters and control variables of HFV 3 haracteristic parameters and control C variables of HFV Three parameters determine oscillatory ventilation (figure 3.1): Firstly, there is the mean airway pressure (MAP) around which the pressure oscillates; Secondly, the oscillatory volume, which results from the pressure swings and essentially determines the effective­ ess of this n type of mechanical ventilation; Thirdly, the oscillatory frequency denotes the number of cycles per unit of time. Time Figure 3.1: Characteristic variables MAP, amplitude, and frequency in pressure...

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