Diferencia entre revisiones de «High frequency oscillation ventilation»
| Línea 2: | Línea 2: | ||
*High Frequency Oscillation Ventilation (HFOV) is an alternative method for mechanical ventilation in difficult to oxygenate in critically ill ARDS patients. | *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 | *Studied in patients with PaO2/FiO2 < 200 | ||
*Goal is to maintain alveolar recruitment for adequate gas exchange and decrease lung injury/atelectrauma | |||
* See [https://www.wikijournalclub.org/wiki/OSCILLATE Oscillate] trial | * See [https://www.wikijournalclub.org/wiki/OSCILLATE Oscillate] trial | ||
Revisión del 18:52 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
- See Oscillate trial
Procedure
Ventilator protocol from the Oscillate trial
- Recruitment maneuver of 40 cmH2O PEEP for 40 seconds
- Initiate high frequency ventilation -> 3-15Hz
- I:E time of 1:2
- VT minimized to keep pH >7.25
- Goal of 1-4 ml/Kg
- Maitain 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
Mechanism
- Low tidal volumes
- Delivered at high frequency
- Maintains lung recruitment
- Reduces Ventilator Induced Lung Injury (VILI) from recruitment and de-recruitment
Pros and Cons
- Pros
- Limits VILI
- Cons
- No difference or likely to cause harm in adult ARDS patients