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VIASYS HEALTHCARE INTERNATIONAL

VIASYS HEALTHCARE INTERNATIONAL. Oslo, November 2006 High Frequency Oscillation. SensorMedics 3100. High Frequency Ventilation Modes:. HFPPV : High Frequency Positive Pressure Ventilation HFFI : High Frequency Flow Interruption HFJV : High Frequency Jet Ventilation

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VIASYS HEALTHCARE INTERNATIONAL

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  1. VIASYS HEALTHCARE INTERNATIONAL

  2. Oslo, November 2006High Frequency Oscillation SensorMedics 3100

  3. High Frequency Ventilation Modes: • HFPPV : High Frequency Positive Pressure Ventilation • HFFI : High Frequency Flow Interruption • HFJV : High Frequency Jet Ventilation • HFOV : High Frequency Oscillating Ventilation

  4. Pig model 3 kg with RDS PCV PEEP : 7 cm H2O MAP : 15 cm H2O PIP : 24 cm H2O Zoneof Overdistention Injury “Safe” Window Volume Zone of Derecruitment and Atelectasis Injury Pressure Pulmonary Injury Sequence • There are two injury zones during mechanical ventilation • Low Lung Volume Ventilation tears adhesive surfaces • High Lung Volume Ventilation over-distends, resulting in “Volutrauma” • The difficulty is finding the “Sweet Spot” Froese AB, Crit Care Med 1997; 25:906

  5. Sensormedics 3100A HFO Ventilator 2 Principles: 1) Oxygenation (O2) CPAP 2) Ventilation (CO2) Oscillation

  6. Principle 1: CDP Adjust Valve ET Tube Oscillator Patient BIAS Flow Increase Lungvolume with a “super CPAP system”

  7. Optimized Lung Volume Strategy: CT Scan : RDS pig model 3 kg Continuous Distending Pressure 5 cm H2O

  8. Optimized Lung Volume Strategy: CT Scan : RDS pig model 3 kg Continuous Distending Pressure 12 cm H2O

  9. Optimized Lung Volume Strategy: CT Scan : RDS pig model 3 kg Continuous Distending Pressure 20 cm H2O

  10. CT 2 CT 1 CT 3 • CDP = • Lung Volume Paw = CDP Continuous Distending Pressure

  11. Oxygenation-Pressure Curve

  12. Expiration = ACTIVE No Airtrapping Disconnection Oxygenation from Ventilation Principle 2: CDP Adjust Valve ET Tube Oscillator Patient BIAS Flow Decrease TV’s to physiological dead space and increase frequency (0.1 – 2ml/Kg)

  13. + + - - + + Amplitude CDP/Lung volume CDP/Lung volume - -

  14. Optimized Lung Volume Strategy: • 2.) Decrease Tidal Volumes to less or equal then dead space • and increase frequency ! Benefits: - enhanced gas exchange doe to combined gas transport mechanisms - no excessive volume swings - reduced regional overinflation and stretching - reduced Volutrauma

  15. GAS EXCHANGE IN HFOV: 1.)Convection (Bulk Flow) Ventilation 2.) Asymetrical Velocity Profile 3.) Taylor Dispersion 4.) Molecular Diffusion 5.) Pendelluft 6.) Cardiogenic Mixing

  16. SUGGESTED READING : • Chang HK. Mechanisms of gas transport during ventilation by HFOV, Brief Review, J Appl Physiol, 1994 • Schindler M, et al. Effect of Lung Mechanics on Gas Transport During HFO. Pediatric Pulmonology, 1991

  17. Pressure transmission CMV / HFOV : • Distal amplitude measurements with alveolar capsules in animals, demonstrate it to be greatly reduced or “attenuated” as the pressure traverses through the airways. • Due to the attenuation of the pressure wave, by the time it reaches the alveolar region, it is reduced down to .1 - 5 cmH2O. Gerstman et al

  18. I + + + Amlitude Delta P = TV = Ventilation + + + CDP = Lungvolume = Oxygenation + + + + _ _ _ _ _ _ _ _ _ E Airway Pressure Transmission HFOV : Pressure ET Tube Trachea Alveolus Transmission

  19. HFOV Principle:Pressure curves CMV / HFOV Injury Injury

  20. CMV Stable Aveoli

  21. CMV Instable Aveoli versus HFOV Carney et al. Crit Care Med 2005;33:S122-S128

  22. CMV Instable Aveoli versus HFOV - 2

  23. Dynamic Multiscan CT: Method airway pressure CT-acquisition time

  24. After lavage, Step up

  25. After lavage, Step down

  26. Dynamic Multiscan CT: Results

  27. D Pressure (Amplitude) controls CO2 CDP controls O2

  28. CLINICAL APPLICATIONS • Neonatal • Prematurity / RDS • Surfactant Distribution • PPHN • Pneumonia's • Meconium Aspirations • Blood Aspirations • Hypoplasias • CDH • Pulmonary Hypoplasia • > 24 hrs. > 40 % FiO2 • Neonatal Airleaks • PIE • Pneumothoraces • Pneumomediastinum • Pneumoperitoneum

  29. Pulmonary Injury Sequence: • If we cannot prevent the injury sequence , then the • target goal is to interrupt the sequence of events ! • High Frequency Oscillation does not reverse injury, • but will interrupt the progression of injury

  30. HFOV effectively decouples:Oxygenation & Ventilation

  31. 3100 A HFOV Resume: • Less Oxygen exposure: • Stable lung inflation • Recruitment of alveolar space • Improved matching V/Q • Reduction of Volutrauma: • No conventional breaths • Less Volume swings • No high peak pressures • Active Exhalation • Reduces Airtrapping • Reduces Airway stretch • Sufficient Humidification • less risk NTB HFOV effectively decouples Oxygenation and Ventilation

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