1. 1 HFPV VDR4 ® Definition: “The VDR ® is classified as a pneumatically powered, pressure regulated, time cycled, high frequency flow interrupter.” - Delivers high frequency in a range of 200-900 cycles/min. - Passive exhalation Adel Bougatef MD, PhD.

2. Inspiration (I) Expiration (E) Pressure Time (sec) e i OD.CPAP - I / E ratio : conventional rate expressed in seconds. - i / e ratio : high frequency rate expressed in milliseconds. Plateau equilibrium Step inflation lung Typicale HFPV waveform

3. Inspiratory Time Pulsatile Flowrate (PIP) Osc./Demand CPAP Expiratory Time Pulse Frequency Pulse i:e Ratio Conv. Pressure Rise

4. HFPV VDR4 : NEONATAL SET-UP IT = 1 to 1.2 sec ET = 0.6 to 0.8 sec ( I/E ≈ 1/1 for Low Frequency = 38 a 42 cycles/min) HF = 600 to 800 cycles/min i/e = 1 / 1 to 1/1.5 PIP = 25 to 30 cm H 2 O Oscillatory CPAP = 6 cm H 2 O FiO2 : 1 (and according to BGA) Demande CPAP/PEEP = O ! Diffusion Problems (H.M.D) IE PIP ie

5. HFPV VDR4 : NEONATAL SET-UP IT = 1.1 to 1.4 sec ET = 0.6 to 0.8 sec ( I/E ≈ 1/1 for Low Frequency = 35 a 40 cycles/min) HF = 500 to 700 cycles/min i/e = 1 / 1.5 to 1/2.2 PIP = 35 to 45 cm H 2 O Oscillatory CPAP = 4 to 6 cm H 2 O FiO2 : 1 (and according to BGA) Demande CPAP/PEEP = O ! Perfusion Problems (P.P.H.N) PIP I E i e

6. CO 2 Washout i/e (1/2.5 - 1/3.5) HF ( ≈ 500 cycles/min) ET to Low frequency Progressive PIP by level of 2 cmH 2 O Convective Pressure rise.

7. Oxygenation i/e (1/1) HF ( 600 - 800 cycles/min) IT, ET will be adjusted for I/E =1.5/1 FIO 2 Osc. CPAP Convective Pressure rise. Progressive PIP by level of 2 cmH 2 O Convective Pressure rise.

8. VDR SET UP FIO2: SPO2 ≈ 92 to 95 % I Time: 1 seconds E Time: 0.7 seconds Low rate: ≈ 40 Pulse Frequency: ≈ 800 Pulsatile Flowrate: 25 - 30 cm H2O Oscillatory cpap: 6 cm H2O DIFFUSION COMPONENT PIP/PEEP/FIO2 To keep: Ph ≥ 7.30, SpO2 ≈ 92-95%, PaCO2 ≈ 35-45 mm Hg Obtain: Chest XRay, ABG, Within 2 hours of VDR set Up If: SPO2 < 90 or PaO2 < 50 mmHg 1. Pulsatile Flowrate 2 cm H2O increment. 2.,, Oscillatory Cpap. 3.,, Pulse Frequency ( i/e more diffusve). 4.,, Inspiratory Time 0.1 second increment. 5.,, FIO2. 6. Add Convective Pressure Rise. Yes If: PaCO2 > 45 mmHg 1. Pulsatile Flowrate 2 cm H2O increment. 2. Inspiratory Time 0.1 second increment. 3. Reduce Pulse Frequency ( i/e: 1/2 to 1/3). 4.,,,,,, Oscillatory Cpap. 5. Add Convective Pressure Rise. 6. Assess for airway obstruction. If: PaCO2 < 30 mmHg 1. Pulsatile Flowrate 2 cm H2O increment. 2. Expiratory Time. 3. Pulse Frequency ( i/e: 1/1). 4. Oscillatory Cpap if SPO2 ≥ 95 %. If SPO2 ≥ 95 % then: Reduce FIO2 10 % increment (25% lower limit). Reduce Pulsatile Flowrate 2 cm H2O increment. Reduce Oscillatory Cpap by 1cm H2O increment. Don’t reduce Osc.Cpap < 4 cm H2O. Concider Extubation when: FIO2 ≤ 30 %. Pulsatile Flowrate < 20 cm H2O. Low rate ≤ 20 cycles /min. With I time ≈ 1.2 second. Chest X-Ray with minimal infiltrates. Transition To Nasal Cpap To reduce W.O.B. Yes if X-Ray OK

9. VDR SET UP FIO2: SPO2 ≈ 92 to 95 % I Time: 1.2 seconds E Time: 0.8 seconds Low rate: ≈ 36 Pulse Frequency: ≈ 500 (with i/e: 1/2) Pulsatile Flowrate: 35 - 45 cm H2O Oscillatory cpap: 6 cm H2O PERFUSION COMPONENT PIP/PEEP/FIO2 To keep: Ph ≥ 7.30, SpO2 ≈ 92-95%, PaCO2 ≈ 35-45 mm Hg Obtain: Chest XRay, ABG, Within 2 hours of VDR set Up If: SPO2 < 90 or PaO2 < 50 mmHg 1. Pulsatile Flowrate 2 cm H2O increment. 2. Add Convective Pressure Rise. 3. Oscillatory Cpap. 4.,, Inspiratory Time 0.1 second increment. 5.,, FIO2. If: PaCO2 > 45 mmHg 1. Pulsatile Flowrate 2 cm H2O increment. 2. Inspiratory Time 0.1 second increment. 3. Reduce Pulse Frequency ( i/e: 1/2 to 1/3). 4.,,,,,, Oscillatory Cpap. 5. Add Convective Pressure Rise. 6. Assess for airway obstruction. If: PaCO2 < 30 mmHg 1. Pulsatile Flowrate 2 cm H2O increment. 2. Expiratory Time. 3. Pulse Frequency ( i/e: 1/1). 4. Oscillatory Cpap if SPO2 ≥ 95 %. If SPO2 ≥ 95 % then: Reduce FIO2 10 % increment (25% lower limit). Reduce Pulsatile Flowrate 2 cm H2O increment. Reduce Oscillatory Cpap by 1cm H2O increment. Don’t reduce Osc.Cpap < 4 cm H2O. Concider Extubation when: FIO2 ≤ 30 %. Pulsatile Flowrate < 20 cm H2O. Low rate ≤ 20 cycles /min. With I time ≈ 1.2 second. Chest X-Ray with minimal infiltrates. Transition To Nasal Cpap To reduce W.O.B. Yes if X-Ray OK

10. HFPV for NEONATAL TRANSPORT

11. Pressure Time Sinusoidal Bronchotron (HFPV transport) H.F