Diferencia entre revisiones de «High frequency oscillation ventilation»
Sin resumen de edición |
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| Línea 12: | Línea 12: | ||
*Recruitment maneuver of 40 cmH2O PEEP for 40 seconds | *Recruitment maneuver of 40 cmH2O PEEP for 40 seconds | ||
*I:E time of 1:2 | *I:E time of 1:2 | ||
*Initiate high frequency ventilation -> 3- | *Initiate high frequency ventilation -> 3-15 Hz | ||
*VT minimized to keep pH >7.25 | *VT minimized to keep pH >7.25 | ||
**Goal of 1-4 ml/Kg | **Goal of 1-4 ml/Kg | ||
* | *Maintain mean airway pressure of 30 cmH2O with pressure adjusted to maintain a PaO2 of 55-80 mmHg | ||
*Reversion to standard ventilation of mean airway pressure was ≤24 cmH2O for 12 hours or anytime when ≤20 cmH2O | *Reversion to standard ventilation of mean airway pressure was ≤24 cmH2O for 12 hours or anytime when ≤20 cmH2O | ||
*Re-initiation of HFOV if FIO2 >0.4 or PEEP >14 cmH2O for >1 hour in the subsequent 48 hours | *Re-initiation of HFOV if FIO2 >0.4 or PEEP >14 cmH2O for >1 hour in the subsequent 48 hours | ||
| Línea 23: | Línea 23: | ||
*SpO2 >88% or PaO2 >55mmHg | *SpO2 >88% or PaO2 >55mmHg | ||
'''Oxygenation'''altered by: | '''Oxygenation''' altered by: | ||
* FiO2 | * FiO2 | ||
* Mean airway pressures | * Mean airway pressures | ||
Revisión del 19:08 22 jun 2016
Background
- High Frequency Oscillation Ventilation (HFOV) is an alternative method for mechanical ventilation in difficult to oxygenate in critically ill ARDS patients.
- Studied in patients with PaO2/FiO2 < 200
- Goal is to maintain alveolar recruitment for adequate gas exchange and decrease lung injury/atelectrauma
- Low tidal volumes based around mean airway pressures to keep alveoli open
- Delivered at high frequency
- See Oscillate trial
Procedure
Ventilator protocol from the Oscillate trial
- Set FiO2 at 100%
- Recruitment maneuver of 40 cmH2O PEEP for 40 seconds
- I:E time of 1:2
- Initiate high frequency ventilation -> 3-15 Hz
- VT minimized to keep pH >7.25
- Goal of 1-4 ml/Kg
- Maintain mean airway pressure of 30 cmH2O with pressure adjusted to maintain a PaO2 of 55-80 mmHg
- Reversion to standard ventilation of mean airway pressure was ≤24 cmH2O for 12 hours or anytime when ≤20 cmH2O
- Re-initiation of HFOV if FIO2 >0.4 or PEEP >14 cmH2O for >1 hour in the subsequent 48 hours
Targets
- pH>7.25
- SpO2 >88% or PaO2 >55mmHg
Oxygenation altered by:
- FiO2
- Mean airway pressures
Ventilation altered by:
- Frequency
- Inspiratory time
- Amplitude of oscillations
Pros and Cons
- Pros
- Limits VILI
- May improve oxygenation when ECMO not available
- Cons
- No difference or likely to cause harm in adult ARDS patients
- requires heavy sedation