High Frequency Oscillation
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.
KeywordsTidal Volume Airway Pressure Lung Volume Conventional Mechanical Ventilation Oscillatory Ventilation
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