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Pediatr Crit Care Med. 2008 Jan;9(1):101-4. doi: 10.1097/01.PCC.0000298637.74514.54.

Assessment of neonatal ventilation during high-frequency oscillatory ventilation.

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  • 1Division of Neonatology, Department of Pediatrics, Thomas Jefferson University Hospital, Philadelphia, PA, USA.

Abstract

OBJECTIVE:

To determine alterations in high-frequency oscillatory ventilation (HFOV) performance during clinical ventilator management.

DESIGN:

Clinical investigation.

SETTING:

Two level III intensive care nurseries in Wilmington, Delaware, and Philadelphia, Pennsylvania.

PATIENTS:

Thirty infants 1.49 +/- 1.01 kg with respiratory distress receiving HFOV.

INTERVENTIONS:

Due to the demonstrated benchtop load sensitivity of the HFOV (SensorMedics 3100), we hypothesized that measured tidal volume (Vt/kg) and high-frequency minute ventilation (HFMV) would vary inversely with respiratory rate adjustments and that ventilator performance will be affected with endotracheal tube (ETT) suctioning. Both Vt/kg and HFMV were recorded using a novel hot-wire anemometry technique at the time of ETT suctioning or changes in ventilator settings.

MEASUREMENTS AND MAIN RESULTS:

During HFOV it was found that Vt/kg = 2.52 +/- 0.68 mL/kg and HFMV = 69 +/- 45 ([mL/kg]2 x Hz); effective ventilation was observed in the range of HFMV = 29-113 ([mL/kg]2 x Hz). HFMV decreased with an increase in breathing frequency. Although there was a significant increase in the mean Vt/kg after suctioning events, there was no difference in Vt/kg or HFMV after disconnection of the ETT alone. There were significant alterations in HFOV performance as a result of clinical adjustments in respiratory rate and suctioning. In addition, we found that measured Vt during clinically effective HFOV is at least equivalent to expected deadspace.

CONCLUSIONS:

Measurement of tidal volume and HFMV may be clinically important in optimizing HFOV performance both during ETT suctioning and adjustments to breathing frequency.

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