Diferencia entre revisiones de «High frequency oscillation ventilation»
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==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 | ||
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* See [https://www.wikijournalclub.org/wiki/OSCILLATE Oscillate] trial | * See [https://www.wikijournalclub.org/wiki/OSCILLATE Oscillate] trial | ||
==Procedure== | |||
''Example protocol from Oscillate trial<ref>Fergusson N, Cook D, Guyatt G. High-frequency Oscillation in Early Acute Respiratory Distress Syndrome. NEJM 2013; 368:795-805</ref>'' | ''Example protocol from Oscillate trial<ref>Fergusson N, Cook D, Guyatt G. High-frequency Oscillation in Early Acute Respiratory Distress Syndrome. NEJM 2013; 368:795-805</ref>'' | ||
*Set FiO2 at 100% | *Set FiO2 at 100% | ||
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* Amplitude of oscillations | * Amplitude of oscillations | ||
==See Also== | |||
{{Mechanical ventilation pages}} | |||
[http://www.nejm.org/doi/full/10.1056/NEJMoa1215554#t=article Oscillate] | ==External Links== | ||
*[http://lifeinthefastlane.com/ccc/high-frequency-oscillation-ventilation-hfov/ Life in the Fast Lane] - for an excellent review and tutorial | |||
*[http://www.nejm.org/doi/full/10.1056/NEJMoa1215554#t=article Oscillate] | |||
*[http://www.nejm.org/doi/full/10.1056/NEJMoa1215716#t=article OSCAR] | |||
[ | ==References== | ||
<references/> | |||
[[Category:Pulmonary]][[Category:Critical Care]] | |||
Revisión del 15:35 26 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
- See Oscillate trial
Procedure
Example protocol from Oscillate trial[1]
- 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
- Decrease frequency to increase TV and ventilation
- Inspiratory time
- Amplitude of oscillations
See Also
Mechanical Ventilation Pages
- Noninvasive ventilation
- Intubation
- Mechanical ventilation (main)
- Miscellaneous
External Links
- Life in the Fast Lane - for an excellent review and tutorial
- Oscillate
- OSCAR
References
- ↑ Fergusson N, Cook D, Guyatt G. High-frequency Oscillation in Early Acute Respiratory Distress Syndrome. NEJM 2013; 368:795-805