title: Carbon dioxide elimination and gas displacement vary with piston position during high-frequency oscillatory ventilation.
abstract: BACKGROUND
  Alterations in gas displacement in pediatric patients ventilated with the SensorMedics 3100A high-frequency oscillator are most commonly manipulated by adjusting the amplitude, frequency, and percent inspiratory time. The piston-position-and-displacement indicator is commonly centered and subsequently not adjusted. That practice may limit the clinician's ability to optimize carbon dioxide elimination. We hypothesized that varying the piston position would alter gas displacement and carbon dioxide elimination.
  
  
  METHODS
  We conducted an observational study in a tertiary pediatric intensive care unit and a correlated bench study. In the clinical study, 24 patients were ventilated with a SensorMedics 3100A high-frequency oscillator. Transcutaneously measured carbon dioxide ((tCO(2))) values were documented with the piston-position-and-displacement indicator in left, center, and right positions. In the bench study the oscillator was set and maintained at: mean airway pressure 15 cm H(2)O, inspiratory time 33% of respiratory-cycle time, bias flow 20 L/min. A pneumotachometer attached to a respiratory mechanics monitor was placed between the ventilator circuit and a test lung. Data were collected with the piston-position-and-displacement indicator at the left, center, and right positions with frequencies of 4-14 Hz and amplitudes of 25-55 cm H(2)O. Data were collected over a 3-minute time period for each combination of frequency, amplitude, and piston-position-and-displacement-indicator position. We compared the data with repeated-measures analysis of variance. Pairwise comparisons were performed with a 2-tailed Student's test with Bonferroni correction.
  
  
  RESULTS
  Among the 24 patients (tCO(2)) was significantly associated with the position of the piston (p < 0.007). In the bench study, gas displacement was higher when the piston-position-and-displacement indicator was positioned to the left (than when at the center position) 91.7% of the time (p < 0.0001). When the piston-position-and-displacement indicator was positioned to the right (as compared to the center position), gas displacement was lower 75% of the time (p < 0.0001).
  
  
  CONCLUSIONS
  Adjusting the oscillator piston alters the volume of gas displaced and provides an additional means for titrating carbon dioxide elimination. .
authors.affiliation: Department of Pediatric Critical Care Medicine, Duke University Medical Center, Box 3046, Durham NC 27710, USA. hamel003@mc.duke.edu
authors.forename: Donna S
authors.initials: DS
authors.lastname: Hamel
authors.forename: Andrew L
authors.initials: AL
authors.lastname: Katz
authors.forename: Damian M
authors.initials: DM
authors.lastname: Craig
authors.forename: John D
authors.initials: JD
authors.lastname: Davies
authors.forename: Ira M
authors.initials: IM
authors.lastname: Cheifetz
mesh_terms: D000293:Adolescent; D002245:Carbon Dioxide / Q000493:pharmacokinetics*; D002648:Child; D002675:Child, Preschool; D004867:Equipment Design; D006612:High-Frequency Ventilation / Q000295:instrumentation* / Q000379:methods*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D011659:Pulmonary Gas Exchange; D012131:Respiratory Insufficiency / Q000628:therapy
chemical_list: D002245:Carbon Dioxide