Diferencia entre revisiones de «High frequency oscillation ventilation»
Sin resumen de edición
Línea 3: Línea 3:
*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  
*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 [https://www.wikijournalclub.org/wiki/OSCILLATE Oscillate] trial
* See [https://www.wikijournalclub.org/wiki/OSCILLATE Oscillate] trial


===Procedure===
===Procedure===
''Ventilator protocol from the Oscillate trial''  
''Ventilator protocol from the Oscillate trial''  
*Set FiO2 at 100%
*Recruitment maneuver of 40 cmH2O PEEP for 40 seconds
*Recruitment maneuver of 40 cmH2O PEEP for 40 seconds
*I:E time of 1:2
*Initiate high frequency ventilation -> 3-15Hz
*Initiate high frequency ventilation -> 3-15Hz
**I:E time of 1:2
*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
Línea 16: Línea 19:
*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


===Mechanism===
'''Targets'''
* Low tidal volumes
*pH>7.25
* Delivered at high frequency
*SpO2 >88% or PaO2 >55mmHg
* Maintains lung recruitment
 
** Reduces Ventilator Induced Lung Injury (VILI) from recruitment and de-recruitment
'''Oxygenation'''altered by:
* FiO2
* Mean airway pressures
 
'''Ventilation''' altered by:
* Frequency
* Inspiratory time
* Amplitude of oscillations


===Pros and Cons===
===Pros and Cons===
* Pros
* Pros
** Limits VILI
** Limits VILI
** May improve oxygenation when ECMO not available


* Cons
* Cons
** No difference or likely to cause harm in adult ARDS patients
** No difference or likely to cause harm in adult ARDS patients
** requires heavy sedation

Revisión del 19:07 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 -> 3-15Hz
  • 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

Targets

  • pH>7.25
  • SpO2 >88% or PaO2 >55mmHg

Oxygenationaltered 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
Obtenido de «https://www.wikem.org/w/index.php?title=High_frequency_oscillation_ventilation&oldid=77151»