Assessment of neonatal ventilation during high-frequency oscillatory ventilation.
OBJECTIVE
To determine alterations in high-frequency oscillatory ventilation (HFOV) performance during clinical ventilator management.


METHODS
Clinical investigation.


METHODS
Two level III intensive care nurseries in Wilmington, Delaware, and Philadelphia, Pennsylvania.


METHODS
Thirty infants 1.49 +/- 1.01 kg with respiratory distress receiving HFOV.


METHODS
Due to the demonstrated benchtop load sensitivity of the HFOV (SensorMedics 3100), we hypothesized that measured tidal volume (Vt/kg) and high-frequency minute ventilation (HFMV) would vary inversely with respiratory rate adjustments and that ventilator performance will be affected with endotracheal tube (ETT) suctioning. Both Vt/kg and HFMV were recorded using a novel hot-wire anemometry technique at the time of ETT suctioning or changes in ventilator settings.


RESULTS
During HFOV it was found that Vt/kg = 2.52 +/- 0.68 mL/kg and HFMV = 69 +/- 45 ([mL/kg]2 x Hz); effective ventilation was observed in the range of HFMV = 29-113 ([mL/kg]2 x Hz). HFMV decreased with an increase in breathing frequency. Although there was a significant increase in the mean Vt/kg after suctioning events, there was no difference in Vt/kg or HFMV after disconnection of the ETT alone. There were significant alterations in HFOV performance as a result of clinical adjustments in respiratory rate and suctioning. In addition, we found that measured Vt during clinically effective HFOV is at least equivalent to expected deadspace.


CONCLUSIONS
Measurement of tidal volume and HFMV may be clinically important in optimizing HFOV performance both during ETT suctioning and adjustments to breathing frequency.
Sturtz
Wendy J
WJ
Division of Neonatology, Department of Pediatrics, Thomas Jefferson University Hospital, Philadelphia, PA, USA.
Touch
Suzanne M
SM
Locke
Robert G
RG
Greenspan
Jay S
JS
Shaffer
Thomas H
TH
D003691:Delaware; D006612:High-Frequency Ventilation / Q000592:standards*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D015931:Intensive Care, Neonatal; D007442:Intubation, Intratracheal; D008991:Monitoring, Physiologic / Q000379:methods; D019370:Observation; D017063:Outcome Assessment, Health Care / Q000379:methods; D012121:Respiration, Artificial / Q000295:instrumentation; D012131:Respiratory Insufficiency; D013990:Tidal Volume