External High Frequency Oscillation Research Articles

Negative Pressure Ventilation vs External High-Frequency Oscillation During Rigid Bronchoscopy: A Controlled Randomized Trial

To compare the effectiveness of two modalities of external ventilation during rigid bronchoscopy: intermittent negative pressure ventilation (INPV) and external high-frequency oscillation (EHFO). Prospective, controlled, randomized, nonblinded study. University-affiliated hospital. Seventy patients undergoing interventional rigid bronchoscopy for tracheobronchial lesions were enrolled into the study. Mechanical ventilation was performed by INPV or EHFO. When pulse oximetry was < 90%, manually assisted ventilation was delivered. Arterial blood gases were sampled preoperatively and intraoperatively. Most patients in both groups had normal intraoperative PaCO(2) (mean, 43. 6 +/- 11.8 mm Hg under EHFO and 37.4 +/- 8.2 mm Hg under INPV; p = 0.012), and acidemia occurred in 9 of 35 patients of EHFO group and in 2 of 35 patients of INPV group (p = 0.049). Hypercapnia (PaCO(2) > 50 mm Hg) was observed in 10 patients under EHFO and in 2 with INPV (p = 0.026). Intraoperative mean PaO(2) was similar (101.4 +/- 52.9 mm Hg with EHFO and 124.2 +/- 50.3 mm Hg with INPV; p = 0.07), but O(2) supply was different (3.5 +/- 2.3 L/min during INPV and 8.5 +/- 6.2 L/min during EHFO; p < 0.001). Intraoperative hypoxemia (PaO(2) < 60 mm Hg) occurred in five patients with EHFO and two with INPV (p = 0.426). Three EHFO patients required manually assisted ventilation (mean, 0.2 +/- 0.9), but no INPV patient did (p = 0.142). External negative pressure ventilation appears to be a suitable choice during rigid bronchoscopy: both EHFO and INPV ensure effective ventilation and comfortable operating conditions in the majority of patients. Some patients may receive inadequate ventilation with EHFO, developing respiratory acidosis and requiring manually assisted ventilation. In comparison with INPV, EHFO requires a higher fraction of inspired oxygen.

Effect of external high-frequency oscillation on severe cardiogenic pulmonary edema

Effective gas exchange can be maintained in animals without endotracheal intubation using external high-frequency oscillation (EHFO). The aim of this study was to evaluate the effect of EHFO in patients with respiratory failure due to severe cardiogenic pulmonary edema. Seven patients were ventilated with EHFO for 2h at 60 oscillations·min(-1), with a cuiras pressure of 36 cmH2O (-26 to +10) and an inspiratory to expiratory ratio of 1:1, with EHFO. Blood gas values and hemodynamic parameters were measured. Significant increases were noted in cardiac index (2.3±0.5 to 2.5±0.5 l·m(-2);P<0.05), stroke volume index (24±7 to 28±8 ml·m(-2);P<0.05), and arterial O2 pressure (Pao2) (70±4 to 95±23 mmHg;P<0.01) without a change in pulmonary artery wedge pressure at 1 h after EHFO. The respiratory rate decreased from 28±3 to 22 ±3 breaths·min(-1) at 5 min after the termination of EHFO (P <0.01). Arterial CO2 pressure (Paco2) did not, however, decrease. Increased stroke volume without a change in pulmonary artery wedge pressure (preload) suggests either improved inotropic function of the left ventricle or reduced left ventricular afterload with EHFO. The use of EHFO may be effective not only for gas exchange but also for left ventricular function in patients with severe cardiogenic pulmonary edema.

The combination of external high-frequency oscillation and pressure support ventilation in acute respiratory failure.

Effective gas exchange can be maintained in animals by using external high-frequency oscillation (EHFO). The present study evaluates the effect of relatively long-term duration EHFO combined with pressure support ventilation (PSV) in patients with acute respiratory failure. Twelve patients were ventilated with EHFO combined with PSV for 8 h at 60 oscillations.min-1, with a cuirass pressure of 36 cm H2O: -26 to +10 cm H2O (27 mm Hg: -19.5 to +7.5 mm Hg) and an inspiratory-to-expiratory ratio of 1:1. Blood gas values and hemodynamic parameters were measured. Significant increases were noted in cardiac index (3.0 +/- 0.7 to 3.2 +/- 0.7 1.min-1.m-2, P < 0.05) and stroke volume index (32 +/- 14 to 35 +/- 13 ml.m-2, P < 0.05) without changes in pulmonary artery wedge pressure at 1 h after EHFO. PaO2 (kPa)/FiO2 and PaCO2 improved from 21.9 +/- 7.5 to 26.8 +/- 8.0 (P < 0.05) at 2 h and from 6.9 +/- 1.7 to 6.1 +/- 0.9 (P < 0.01) at 30 min after EHFO, respectively. Breath sounds could be heard well throughout the lung fields after institution of EHFO. The mucous rales also decreased. As a method of ventilation for patients with acute respiratory failure, EHFO combined with PSV may have potential advantages over conventional mechanical ventilation when drainage of secretions if facilitated. Beneficial effects of EHFO may appear after several hours.

External high-frequency oscillation for hypercapnia after upper abdominal surgery.

The purpose of this study was to evaluate the efficacy of external high-frequency oscillation (EHFO) in patients with hypercapnia following upper abdominal surgery. Seven patients were ventilated with EHFO for 2 hr at 60 oscillations/min, with cuirass pressures of 36 cm H2O (-26 to +10), and an inspiratory to expiratory ratio of 1:1. Blood gases and cardiac functional parameters were examined during the 2 hr on EHFO. Pulmonary functional parameters were analyzed prior to the institution and after the termination of EHFO. PaCO2 significantly decreased from 61 +/- 8 mmHg to 48 +/- 7 mmHg after 10 min on EHFO (p < 0.01). PaO2 significantly increased from 74 +/- 10 mmHg 95 +/- 26 mmHg after 1 hr on EHFO (p < 0.01). The heart rate decreased significantly from 108 +/- 27 beats/min to 101 +/- 24 beats/min after 30 min on EHFO (p < 0.05). The FEV1 and FVC significantly increased from 1.09 +/- 0.54 L to 1.50 +/- 0.46 L (p < 0.01) and from 1.90 +/- 0.74 L to 2.18 +/- 0.60 L (p < 0.05), respectively. The other parameters of lung function also significantly improved after the termination of EHFO. The significant changes in all of the pulmonary functional parameters continued for 1 hr after the termination of EHFO. EHFO is an effective method of gas exchange which is associated with earlier return to preoperative lung function.

Ventilation with external high frequency oscillation around a negative baseline increases pulmonary blood flow after the Fontan operation

AbstractIn this prospective study, pulmonary blood flow was measured using transesophageal Doppler echocardiography to assess whether ventilation by means of external high frequency oscillation around a negative pressure baseline can increase pulmonary blood flow, compared to intermittent positive pressure ventilation, in five patients after the Fontan operation. Pulmonary blood flow was measured when patients were ventilated by means of intermittent positive pressure ventilation and again during equivalent negative pressure ventilation using the external oscillatory technique. When compared to that with intermittent positive pressure ventilation, ventilation using external high frequency oscillation increased pulmonary blood flow by 116 ±61.5% (p=0.013). These results show that ventilation using an external oscillatory device with a mean negative chamber pressure may provide hemodynamic advantages in patients requiring assisted ventilation after the Fontan operation.

External High Frequency Oscillation in Normal Subjects and in Mechanically Ventilated Patients

External High Frequency Oscillation in Normal Subjects and in Mechanically Ventilated Patients

External high frequency oscillation in cats. Experience in the normal lung and after saline lung lavage.

In an effort to develop a method of assisted ventilation that would avoid endotracheal intubation, 11 anesthetized, paralyzed, nonintubated adult mongrel cats with normal lungs were externally oscillated by means of a thoracoabdominal chamber connected to a vacuum source and a high frequency oscillator. Chamber pressure was adjusted to the desired negative pressure using the vacuum source, and the animal was then oscillated above and below this pressure. The lowest PaCO2 and AaPO2 were observed at 3 Hz. Tidal volume (VT) fell (p less than 0.001) with increases in frequency, and lung volume (VL) rose with increased negative chamber pressure (p less than 0.001). In 11 additional tracheostomized cats, a stiff lung was created by repeated saline lung lavage. External high frequency oscillation (EHFO), using pressures comparable to those used for conventional mechanical ventilation (CMV), was associated with a significant increase in PaO2 (p less than 0.001), and a significant fall in AaPO2 (p less than 0.01) compared with that during CMV. Lung volume was significantly higher during EHFO (p less than 0.001) and, as in the normal lung, VT fell with increasing frequencies to 15 Hz (p less than 0.001). There were no significant frequency-dependent variations in gas exchange or VL. An increasingly negative mean chamber pressure was associated with a significant increase in PaO2 (p less than 0.05) and VL(p less than 0.005) and a significant decrease in PaCO2 (p less than 0.025).(ABSTRACT TRUNCATED AT 250 WORDS)

Ventilation by high-frequency oscillation of thorax or at trachea in rats

The efficiency of ventilation by high-frequency oscillation (HFO) applied to the thorax (external HFO) has been compared with that of HFO applied through a tracheal cannula (internal HFO) in a group of normal rats. Anesthetized, paralyzed, tracheotomized rats were placed in a whole-body plethysmograph. External HFO was achieved by varying the pressure surrounding the animal by means of a piston pump connected to the body plethysmograph; internal HFO was obtained in the same animals by connecting the pump to the tracheal cannula. Arterial CO2 and O2 partial pressures were measured in blood sampled from a carotid artery and were compared for external and internal HFO applied at 20 Hz with matched tidal volumes of 0.8, 1.4, 1.9, and 2.4 ml/kg. With increasing tidal volume, the mean arterial CO2 partial pressure decreased progressively from 68 to 30 Torr and was identical in the two modes of HFO; no difference was noted for the CO2 elimination or for the arterial O2 partial pressure. These results indicate that, in terms of gas exchange, external and internal HFO are equally efficient in normal rats.