High frequency oscillation ventilation: Difference between revisions
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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  
* See [https://www.wikijournalclub.org/wiki/OSCILLATE Oscillate] trial
**Low tidal volumes based around mean airway pressures to keep alveoli open
**Delivered at high frequency


===Procedure===
===Pros===
''Ventilator protocol from the Oscillate trial''  
*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==
''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%
*Recruitment maneuver of 40 cmH2O PEEP for 40 seconds
*Recruitment maneuver of 40 cmH2O PEEP for 40 seconds
*Initiate high frequency ventilation -> 3-15Hz
*I:E time of 1:2
**I:E time of 1:2
*Initiate high frequency ventilation → 3-15 Hz
*VT minimized to keep pH >7.25
*VT minimized to keep pH >7.25
**Goal of 1-4 ml/Kg
**Goal of 1-4 ml/Kg
*Maitain mean airway pressure of 30 cmH2O with pressure adjusted to maintain a PaO2 of 55-80 mmHg
*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
*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
*Re-initiation of HFOV if FIO2 >0.4 or PEEP >14 cmH2O for >1 hour in the subsequent 48 hours


===Mechanism===
'''Targets'''
* Low tidal volumes
*pH>7.25
* Delivered at high frequency
*SpO2 >88% or PaO2 >55mmHg
* Maintains lung recruitment
 
** Reduces Ventilator Induced Lung Injury (VILI) from recruitment and de-recruitment
'''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}}
 
==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]


===Pros and Cons===
==References==
* Pros
<references/>
** Limits VILI


* Cons
[[Category:Pulmonary]][[Category:Critical Care]]
** No difference or likely to cause harm in adult ARDS patients

Latest revision as of 03:01, 9 February 2017

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

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

External Links

References

  1. ↑ Fergusson N, Cook D, Guyatt G. High-frequency Oscillation in Early Acute Respiratory Distress Syndrome. NEJM 2013; 368:795-805
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