Summary
Controversy exists as to whether limitations in high-frequency oscillation efficiency are caused by the size and shape of the bronchial system, by the lack of low impedant intersegmental gas flow in lung parenchyma, or by inappropriate high-frequency ventilators and ancillary hardware. Our objective in this study using the adult pig as a model of the adult patient was to test whether the adult airway system is suited to the use of high-frequency oscillatory ventilation.
We evaluated the ventilatory effect of a wide range of oscillation frequencies (10-15 to 35-45 Hz), tidal volumes (0.5 to 22.2 ml/kg), and bias flow volumes (10 to 701/min) at a mean airway pressure of 12 ± 1 cm H2O in anesthetized and relaxed pigs who did not have lung injury.
Arterial blood gases are mainly dependent on tidal volume, frequency, and mean airway pressure. A threshold bias flow volume of 35 ± 5 1/min is required to prevent CO2 rebreathing. In the group of light-weight animals (65 to 99 kg), the most efficient frequency band for CO2 elimination was ~ 25 Hz. The most efficient frequency band for arterial oxygenation was found to vary between individuals more than the most efficient frequency band for CO2 elimination. In the group of heavy animals (100 to 140 kg), no most efficient mean frequency could be assessed, probably because the excitation system was limited. We confirmed that tidal volume on its own had an effect on CO2 elimination (“tidal-volume effect”), although CO2 elimination was mainly determined by the product of tidal volume and oscillation frequency.
Conclusions: Adult pigs with a body weight in the range of the weight of clinical adult patients can be ventilated by high-frequency oscillation at tidal volumes smaller than, equal to, or slightly more than anatomical deadspace. The most efficient frequency for gas exchange varied between individuals. Tidal volume had an enhancing effect on CO2 elimination. Failure of adequate ventilation by high-frequency oscillation is caused by a) CO2 rebreathing, b) the avoidance of an appropriate alveolar recruitment strategy, and c) an underpowered, high-frequency ventilatory system (oscillator) that is unable to deliver appropriate pressure oscillations.
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References
Emerson JH (1959) Apparatus for vibrating portions of a patient’s airway. United States Patent Office, 1959, Serial No. 491, 699, patented Dec. 29
Sanders RD (1980) Two ventilatory attachments for bronchoscopes. Del Med J 8:39–71
Sjöstrand U (1980) High-frequency positive pressure ventilation. Crit Care Med 8:345–364
Klain M, Smith RB (1977) High-frequency percutaneous transtracheal jet ventilation. Crit Care Med 5:280–287
Lunkenheimer PP, W Rafflenbeul H, Keller I, Frank HH, Dickuth C (1972) Fuhrmann application of transtracheal pressure-oscillations as a modification of “diffusion respiration”. Br J Anaesth 33:627
Lunkenheimer PP, Keller H, Wallner F et al (1972) Ein Versuch der Messung der Myokardkonsistenz mit Hilfe trans-trachealer Schwingungsanregung des Herzens durch Druckschwankungen. Arch Kreislaufforsch 67:73–83
Butler WJ, Bohn DJ, Bryan AC, Froese AB (1980) Ventilation by high-frequency oscillation in humans. Anesth Analg 59:577–584
Froese AB, Bryan AC (1987) High-frequency ventilation. Am Rev Respir Dis 135:1365–1374
Froese AB (1989) Role of lung volume in lung injury: HFO in the atelectasis-prone lung. Acta Anaesthesiol Scand Suppl 33:126–130
Rehder K, Didier P (1984) Gas transport and pulmonary perfusion during high-frequency ventilation in humans. J Appl Physiol 54:1231–1237
Bond DM, Froese AB (1993) Volume recruitment manoeuvres are less deleterious than persistent low lung volumes in the atelectasis-prone rabbit lung during high-frequency-oscillation. Crit Care Med 21:402–412
Kolton M, Cattran CB, Kent G (1982) Oxygenation during high-frequency ventilation compared with conventional mechanical ventilation in two models of lung injury. Anesth Analg 61:323–332
McCulloch PR, Farkert PG, Froese AB (1988) Lung volume maintenance prevents lung injury during high frequency oscillatory ventilation in surfactant-deficient rabbits. Am Rev Respir Dis 137:1185–1192
Taylor GJ (1953) Dispersion of soluble matter in solvent flowing slowly through a tube. Proc R Soc Lond 205:186–203
Pedley TJ, Corieri P, Kamm RD et al (1994) Gas flow and mixing in the airways. Crit Care Med 22 [Suppl]:S24-S36
Venegas JG, Fredberg JJ (1994) Understanding the pressure cost of ventilation: why does high-frequency ventilation work? Crit Care Med 22 [Suppl]:S49-S57
Lunkenheimer PP, Redmann K, Stroh N et al (1994) High-frequency oscillation in an adult porcine model. Crit Care Med 22 [Suppl]:S37-S48
Slutsky AS, Drazen JM, Kamm RD et al (1980) Effective pulmonary ventilation with small-volume oscillations at high frequency. Science 209:609–611
Clark R, Gerstmanan DR, Null DM et al (1992) Prospective randomized comparison of high-frequency oscillatory and conventional ventilation in respiratory distress syndrome. Pediatrics 99:5–12
Miguet D, Claris O, Lapillonne A et al (1994) Preoperative stabilization using high-frequency oscillatory ventilation in the management of congenital diaphragmatic hernia. Crit Care Med 22 [Suppl]:S77-S82
Sipinkova I, Koller EA, Buess C et al (1994) Mechanical respiratory system input impedance during high-frequency oscillatory ventilation in rabbits. Crit Care Med 22 [Suppl]:S66-S70
Bush EH, Spahn DR, Niederer PF et al (1989) Flow separation, an important mechanism during high-frequency oscillation. J Biomech Eng 111:17–23
Brusasco vT, Knopp J, Schmid ER et al (1984) Ventilation-perfusion relationship during high-frequency ventilation. J Appl Physiol 56:454–458
deLemos RA, Yoder B, McCuring D et al (1992) The use of high-frequency oscillatory ventilation (HFOV) and extracorporeal membrane oxygenation (ECMO) in the management of the term/near term infant with respiratory failure. Early Hum Dev 29:299–303
Slutsky AS, Kamm RD, Rössing TH et al (1981) Effects of frequency, tidal volume and lung volume on C02-elimination in dogs by high frequency (2–30 Hz), low tidal volume ventilation. J Clin Invest 68:1475–1484
Khoo MCK, Slutsky AS, Drazen JM et al (1984) Gas mixing during high-frequency ventilation: an improved model. J Appl Physiol 57:493–506
Mead J (1981) Contribution of comphance of airways to frequency-dependent behaviour of the lungs. J Appl Physiol 51:1507–1514
Tsuno K, Prater P, Kolobow T (1990) Acute lung injury from mechanical ventilation at moderately high airway pressure. J Appl Physiol 69:956–961
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© 1996 Springer-Verlag Italia, Milano
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Redmann, K., Lunkenheimer, P.P., Meurer, G., Fischer, S. (1996). High Frequency Oscillation. In: Gullo, A. (eds) Anaesthesia, Pain, Intensive Care and Emergency Medicine — A.P.I.C.E.. Springer, Milano. https://doi.org/10.1007/978-88-470-2203-4_28
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DOI: https://doi.org/10.1007/978-88-470-2203-4_28
Publisher Name: Springer, Milano
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