Abstract
High-frequency oscillatory ventilation (HFOV), which uses a small tidal volume and a high respiratory rate, is considered a type of protective lung ventilation that can be beneficial for certain patients. A disadvantage of HFOV is its limited monitoring of lung mechanics, which complicates its settings and optimal adjustment. Recent studies have shown that respiratory system reactance (Xrs) could be a promising parameter in the evaluation of respiratory system mechanics in HFOV. The aim of this study was to verify in vitro that a change in respiratory system mechanics during HFOV can be monitored by evaluating Xrs. We built an experimental system consisting of a 3100B high-frequency oscillatory ventilator, a physical model of the respiratory system with constant compliance, and a system for pressure and flow measurements. During the experiment, models of different constant compliance were connected to HFOV, and Xrs was derived from the impedance of the physical model that was calculated from the spectral density of airway opening pressure and spectral cross-power density of gas flow and airway opening pressure. The calculated Xrs changed with the change of compliance of the physical model of the respiratory system. This method enabled monitoring of the trend in the respiratory system compliance during HFOV, and has the potential to optimize the mean pressure setting in HFOV in clinical practice.
Highlights
High-frequency oscillatory ventilation (HFOV) is a non-conventional mode of mechanical lung ventilation with a protective potential [1]
HFOV is mainly used in patients suffering from acute respiratory distress syndrome (ARDS) who do not tolerate conventional mechanical ventilation (CMV) [2]
The optimal management of HFOV, including continuous distension pressure (CDP), which would be based on knowledge of lung mechanics of the patient, is unresolved, which could have contributed to inconsistent or negative conclusions of large multicenter HFOV
Summary
High-frequency oscillatory ventilation (HFOV) is a non-conventional mode of mechanical lung ventilation with a protective potential [1]. HFOV is mainly used in patients suffering from acute respiratory distress syndrome (ARDS) who do not tolerate conventional mechanical ventilation (CMV) [2]. HFOV uses pressure oscillations to ensure effective elimination of carbon dioxide from the lungs of the ventilated subject. These pressure oscillations are superimposed on the continuous distension pressure (CDP), which keeps the lungs recruited, and together with the set fraction of inspired oxygen, ensures the oxygenation of the ventilated subject [3]. Recent studies have shown that an individual approach to HFOV settings could improve the patient’s outcome [13,14]. A lack of an individual approach to HFOV settings could have affected the outcome of earlier studies [18,19]
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