SLE5000 HFO Ventilation.

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Presentation transcript:

SLE5000 HFO Ventilation

SLE5000 HFO Ventilation

HFO Studies – 2014-15 The SLE5000 was the most powerful neonatal HFO ventilator in terms of volume delivery with performance similar to that of the Sensormedics 3100A New Generation Neonatal High Frequency Ventilators: Effect of Oscillatory Frequency and Working Principles on Performance Serge Grazioli MD, Oliver Karam MSc MD, and Peter C Rimensberger MD; Respir. Care 2015 The Sensormedics A and B and the SLE5000 delivered square waves; all the other oscillators generated sine waves Pressure and Flow Waveform Characteristics of Eight High-Frequency Oscillators Edward R. Harcourt, BSc; Jubal John, MD; Peter A. Dargaville, MD; Emanuela Zannin, PhD; Peter G. Davis, MD; David G. Tingay, PhD; PCCM 2014

Pressure and flow waveform characteristics of seven high frequency ventilators Figure 1. Representative Pao and V’ao waveforms during two oscillatory cycles for each HFV tested. Unique incisurae patterns were noted within the waveforms of the SM3100B and SLE5000. “The Sensormedics A and B and the SLE5000 delivered square waves; all the other oscillators generated sine waves.” Pressure and Flow Waveform Characteristics of Eight High-Frequency Oscillators Edward R. Harcourt, BSc; Jubal John, MD; Peter A. Dargaville, MD; Emanuela Zannin, PhD; Peter G. Davis, MD; David G. Tingay, PhD; PCCM 2014

Pressure and flow waveform characteristics (cont.)

8 Ventilators Pressure waveforms at 5Hz 10Hz 15Hz

Pressure and Flow Waveforms

Rapid rise in pressure (approx Rapid rise in pressure (approx. 1/100 s) from the SLE5000 and Sensormedics. Greater amplitude achieved by SLE5000 on same settings.

Period: 0.1s at 10Hz Period: 0.1s at 10Hz Rapid rise in pressure in approx. 1/100 s Slower rise in pressure in approx. 1/20 s The pressure wave created by the rapid rise in pressure from the SLE5000 contains much more energy than the slow rise in pressure from the other ventilators.

0.1s 0.1s Rapid rise in pressure in approx. 1/100 s Slower rise in pressure in approx. 1/30 s

0.1s 0.1s Rapid rise in pressure in approx. 1/100 s Slower rise in pressure in approx. 1/20 s

The settings for all ventilators were: Mean pressure: 10mbar; Amplitude: 30mbar (+/-15mbar) …thus, target pressures: -5mbar to +25mbar. Target Amplitude -5 to +25mb Only the SLE achieved the target negative pressure of -5mbar (-7.2mbar at 10Hz). Even the Sensormedics 3100B failed to achieve a negative pressure. Amplitude 21.4 (21.7 to 0.3) in 1:2 i:e ratio 15.9 (17.0 to 1.1) in 1:1 i:e ratio

Greatest amplitude was achieved by the SLE5000 at 23.4 mbar. Ventilator I:E Ratio Peak Pressure Trough Pressure Amplitude % Target Amplitude Target Ventilator Settings 25.0 -5.0 30.0 Sensormedics 3100A 1:2 16.3 3.0 13.3 44% 1:1 16.5 0.7 15.8 53% Sensormedics 3100B 21.7 0.3 21.4 71% 17.0 1.1 15.9 SLE5000 16.2 -7.2 23.4 78% Fabian 15.6 15.3 51% Leonie+ 13.9 0.8 13.1 Sophiea 14.3 -0.3 14.6 49% VN500 12.8 43% BL8000b 10.7 2.2 8.5 28% Data from Table 1, Harcourt et al, PCCM 2014 Greatest amplitude was achieved by the SLE5000 at 23.4 mbar.

Amplitude maintained at higher frequencies Amplitude reduces at higher frequencies

Reducing the frequency to achieve greater amplitude (slower oscillation) risks over-distending the lung (according to Dr Peter Rimensberger speaking on HFO at EAPS 2014). At higher frequencies, the lung does not have time to stretch even at high amplitude oscillation around the appropriate mean pressure.

All the ventilators capable of conventional ventilation and HFO, except for the SLE5000, lost amplitude in the pressure waveform at 10 Hz and lost more pressure at 15Hz.

Rimensberger, Resp. Care 2015 Simulated Term infant 4kg: resistance 70cmH2O/L/s compliance 4mL/cmH2O Mean airway pressure 15 cm H2O , :E 1:1. “Note that, at a frequency of 15 Hz under full-term infant settings, the Babylog VN500 was not able to increase the pressure amplitude beyond 36 cm H2O (white marker)”

Rimensberger, Resp. Care 2015 “The SLE5000 was the most powerful neonatal HFO ventilator in terms of volume delivery with a performance similar to that of the Sensormedics 3100A.”