Several types of HFV  HFPPV  HFJV  HFOV. Principles of Oscillation Richard F. Kita BS, RRT, RCP Edited by Paula Lussier, CRT, NPS, RCP, BS.

Slides:



Advertisements
Similar presentations
HFOV Presented by SAYU ABRAHAM
Advertisements

Neonatal Mechanical Ventilation
The Map Between Lung Mechanics and Tissue Oxygenation The Map Between Lung Mechanics and Tissue Oxygenation.
CPAP/PSV.
Respiratory Calculations
Mechanical Ventilaton Ramon Garza III, M.D.. Indications Airway instability Most surgical patients or trauma Primary Respirator Failure Mostly medical.
Educational Resources
HFOV high frequency Oscillatory Ventilation
Respiration. How does respiration take place? There are two respiratory movements: Inspiration (inhalation) Expiration (exhalation) When you inhale, air.
Tutorial: Pulmonary Function--Dr. Bhutani Clinical Case 695 g male neonate with RDS, treated with surfactant and on ventilatory 18 hours age:
Mechanical Ventilation in the Neonate RC 290 CPAP Indications: Refractory Hypoxemia –PaO2 –Many hospitals use 50% as the upper limit before changing.
Neonatal Options for the 3100A. VIASYS Healthcare, Inc. Neonatal Options for the 3100A Early Intervention Pro-Active Rescue.
3100B Theory of Operation and Controls. VIASYS Healthcare, Inc. 3100B Theory of Operation and Controls Approved for sale outside the US in 1998 for patients.
Initiation of Mechanical Ventilation
3100A Ventilator. VIASYS Healthcare, Inc. 3100A Ventilator Approved in 1991 for Neonatal Application for the treatment of all forms of respiratory failure.
High Frequency Ventilation
Topic 6.4 – Gas Exchange.
The Respiratory system Pulmonary ventilation – Chp 16 Respiration.
Mechanical Ventilation. Epidemiology 28 day international study –361 ICUs in 20 countries –All consecutive adult patients who received MV for > 12 hours.
1 HFPV VDR4 ® Definition: “The VDR ® is classified as a pneumatically powered, pressure regulated, time cycled, high frequency flow interrupter.” - Delivers.
Ventilator.
Minute Respiratory Volume (MRV) Definition: it is total volume of new air that enters respiratory passages per minute Formula: Minute Resp. Volume= V T.
Ventilation / Ventilation Control Tests
08/14/061 HFOV vs. Conventional Ventilation Latoya Robinson Julie Ordones Joshua Globke Matthew Heaton.
Theory of HFV.
1.Choice of Oscillator & Jet Ventilator (15 min) 2.Choice of High Flow & Nasal CPAP (20 to 30 min) 3.Trials in 2008 of CPAP & SIPAP (5 min) 4. ROP Data.
1 Elsevier items and derived items © 2010 by Saunders, an imprint of Elsevier Inc. Chapter 19 Mechanical Ventilation of the Neonate and Pediatric Patient.
Ventilators All you need to know is….
1 © 2013 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part, except for use as permitted in a license.
Respiratory Physiology Part I
Without reference, identify principles about volume/pressure and high frequency ventilators with at least 70 percent accuracy.
CPAP Murila fv. Respiratory distress syndrome 28% of neonatal deaths are due to prematurity The most common respiratory disorder in the preterm is Respiratory.
Effect of different cycling off criteria and positive end-expiratory pressure during pressure support ventilation in patients with chronic obstructive.
Human Anatomy and Physiology Physiology of air breathing The lungs.
High Frequency Ventilation - Back to Basics
Introduction to High Frequency Ventilation
3100B Theory of Operation and Controls. SensorMedics 3100B u Electrically powered, electronically controlled piston-diaphragm oscillator u Paw of 5 -
Neonatal Ventilation: “The Bivent”
Mechanics of Breathing. Events of Respiration  Pulmonary ventilation – moving air in and out of the lungs  External respiration – gas exchange between.
HFV - HFOV SAMANTHA DURHAM & RAJBEER SINGH. What is HFV and types of HFV?  High frequency jet ventilation  high frequency oscillatory ventilation, 
1 Dr.Wahid Helmy pediatric consultant. Basics of Mechanical Ventilation in Neonates.
Advanced Modes of CMV RC 270. Pressure Support = mode that supports spontaneous breathing A preset pressure is applied to the airway with each spontaneous.
Respiratory support and respiratory outcome in preterm infants PD Dr. med. Ulrich Thome Division of Neonatolgy and Pediatric Critical Care University Children’s.
Mechanical Ventilation EMS Professions Temple College.
1 HFPV VDR4 ® Definition: “The VDR ® is classified as a pneumatically powered, pressure regulated, time cycled, high frequency flow interrupter.” - Delivers.
Mechanical Ventilation Mary P. Martinasek BS, RRT Director of Clinical Education Hillsborough Community College.
Basic Concepts in Adult Mechanical Ventilation
Nonatology: Neonatal Respiratory Distress Lecture Points Neonatal pulmonary function Clinical Manifestation The main causes Main types of the disease.
Prevention and Treatment of Ventilator-Induced Lung Injury with
HIGH FREQUENCY VENTILATION (HFV)
Getting Inspired by High Frequency Jet Ventilation Clinical Applications and Optimization.
Clinical Simulations for the Life Pulse HFJV IMPORTANT: Tap or click on the slide to advance. Do not use the navigation arrows.
Ventilator Management James Eakins, MD FACS Director, Trauma and Surgical Critical Care Hahnemann University Hospital.
Lung Protective Jet Ventilation Basic Lung Protective Strategy for Treating RDS and Air Leaks with HFJV.
BY: NICOLE STEVENS.  Primary objective of mechanical ventilation is to support breathing until neonates own respiratory efforts are sufficient  First.
1 Elsevier items and derived items © 2010 by Saunders, an imprint of Elsevier Inc. Chapter 20 Neonatal and Pediatric High-Frequency Ventilation.
Day 2 Agenda: Look over 6 weeks grades Conduct lung volume lab.
 Understand the dual control concept  Understand the pressure regulation mechanism in PRVC  Demonstration of PRVC  Settings and adjustment with Servo.
HIGH FREQUENCY OSCILLATORY VENTILATION
The Spirometry 1 Dr Mazen Qusaibaty MD, DIS / Head Pulmonary and Internist Department Ibnalnafisse Hospital Ministry of Syrian health –
PRESSURE CONTROL VENTILATION
Ventilator-Induced Lung Injury N Engl J Med 2013;369: Arthur S. Slutsky, M.D., and V. Marco Ranieri, M.D 호흡기 내과 / R4 이민혜 Review Article.
Ventilation Strategies in Newborn
High Frequency Oscillatory Ventilation
Mechanical Ventilator 1
Basic Concepts in Adult Mechanical Ventilation
High Frequency Oscillatory Ventilation
Richard Ditsch, BS, RRT, RCVT Clinical Education Specialist
The Respiratory System
VENTILATION.
Presentation transcript:

Several types of HFV  HFPPV  HFJV  HFOV

Principles of Oscillation Richard F. Kita BS, RRT, RCP Edited by Paula Lussier, CRT, NPS, RCP, BS

HFOV  Hi-Frequency Oscillatory Ventilation  Small volumes of gas are moved in and out of ETT  Frequency: cycles/min or 3-15 Hz  Vt<Vd  Active Inspiration and Exhalation

HFOV Development  Improve gas exchange in patients with severe respiratory failure  Decrease ventilator lung injuries  prevent volutrauma  decrease exposure to high FIO2  Reduce lung morbidity  Allow severe pulmonary airleaks to heal

HFOV Indications  Persistent air leak  PIE

HFOV Indications  Persistent respiratory failure associated with:  RDS  Pneumonia  MAS  Congenital diaphragmatic hernia  Pulmonary hemmorage

HFOV Contraindications  Shock

HFOV - Theory of Operation  Specifically Sensormedic 3100A  The driver/oscillator is magnetically driven like an audio speaker  Provides a push/pull of the entire bias gas flow  Push/pull creates an oscillatory (sinusoidal ) wave  E.G. Throwing a stone in a pond.

HFOV - Theory of Operation

 Gas movement occurs by : “shaking gas into and out of the alveoli”  Enhanced molecular movement  Enhanced convection

HFOV - Theory of Operation  Oscillatory Wave is characterized by three factors:  Mean Airway Pressure (Paw) - the average pressure throughout one cycle  Amplitude - the size of the pressure wave  Frequency - the number of cycles per minute  All controlled by electrical current through the electromagnet

HFOV - Theory of Operation  All pressures are measured at circuit wye.  Distal pressures are lower due to attenuation

Goals of HFOV  Decrease Pulmonary Injury Sequence (PIS)  Oxygenation  Ventilation

Pulmonary Injury Sequence  Tidal volume breathing in a surfactant deficient lung can lead to injury  Surfactant replacement can reduce lung injury  Decreasing tidal volume breathing can reduce lung injury  Optimizing lung volume can reduce lung injury

Oxygenation Goals  Maximize gas exchange area  Oxygenation is related more to alveolar recruitment and mean airway pressure  Minimize pulmonary vascular resistance  Optimize cardiac/pulmonary blood flow

Oxygenation Goals  Directly related to lung inflation  utilize MAP to create a continuously distending lung pressure  Find the Optimal Lung Volume (maximize gas exchange area)  improve alveolar compliance  decrease regional over distension  decrease lung injury / PVR  Generally increasing MAP:  Recruits alveoli (improved lung volume)

Oxygenation Goals  Optimal Lung Volume strategy:  Start MAP:  Improves Ventilation/Perfusion matching  Dependant on FIO2  Neonatal: 1-2 cwp higher than conventional ventilation  Improves oxygenation

Optimal Lung Volume  For neonates:  Early intervention: MAP cwp  Early lung injury: MAP cwp  Late lung Injury: Map > 18 cwp

Optimal Lung Volume  Determined by CXR  Right diaphragm at ribs of expansion  Intercostal bulging / flattened diaphragms  Once reached, wean FIO2 before MAP

Over Distension  Can cause pCO2 to increase  Compress pulmonary capillary blood vessels  Increase PVR

Ventilation  For CV Minute Ventilation = Rate x Vt  For HFOV Minute Ventilation = Rate x (Vt) squared  Increase frequency, decrease Vt  Decrease frequency, increase Vt

Ventilation  Frequency is measured in Hz  1 Hz = 60 cycles/min  Usual neonatal range: 8-15 Hz  Preterm infant with severe RDS: Hz  Preterm infant with mild RDS or early chronic changes: Hz  Term infant with severe pneumonia or MAS: 8 Hz

Ventilation  Amplitude of the oscillatory wave (delta P) is set by adjusting the Power Control  Increasing Delta P, increases the amplitude of the oscillatory wave  Measured at circuit wye  Remember, the Delta P is markedly attenuated by the time it reaches the alveoli  Increasing the Delta P, increases chest movement and decreases CO2  Small Delta P changes can result in large CO2 changes

Ventilation  Amplitude  Neonates:  In general start at same level as PIP on conventional ventilation  Early intervention: Delta P cwp  Lung injury: Delta P > 25 cwp

Ventilation  In all patients adjust the Delta P for “Chest Wiggle”  Chest wiggle is the chest movement observed on the patient  Chest Wiggle Assessment:  1+: to the nipple line  2+: to the navel  3+: to or past the groin  Goal is for chest wiggle to reach the navel

Ventilation  Percent Inspiratory Time is always set to 33%, resulting in an I:E Ratio of 1:2

Ventilation  Bias Flow or the continuous flow through the circuit is measured in LPM.  For setup and calibration the flow is adjusted to 20 LPM  In general larger patients need more flow:  Premature infant < 1000 grams, flow = 6-8 LPM  Premature infant grams, flow = LPM  Term infant with MAS flow = LPM

Weaning  After reaching Optimal Lung Volume, wean FIO2 < 40% as tolerated  Wean MAP and Delta P as patient improves  As compliance increases mean lung volume will increase  MAP goals of 8-12 cwp  Frequency is usually not changed once initially set  Go slow  Can be weaned directly from HFOV to extubation, or another mode of ventilation