Diferencia entre revisiones de «High frequency oscillation ventilation»
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===Background===
===Background===
*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  
*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
** Low tidal volumes based around mean airway pressures to keep alveoli open
** Delivered at high frequency
** Delivered at high frequency
* 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
** Increase mean airway pressures may result in more hemodynamic instability
* See [https://www.wikijournalclub.org/wiki/OSCILLATE Oscillate] trial
* See [https://www.wikijournalclub.org/wiki/OSCILLATE Oscillate] trial


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* Inspiratory time
* Inspiratory time
* Amplitude of oscillations
* 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

Revisión del 19:10 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
  • 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
    • Increase mean airway pressures may result in more hemodynamic instability

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
Obtenido de «https://www.wikem.org/w/index.php?title=High_frequency_oscillation_ventilation&oldid=77153»