High-frequency ventilation
Encyclopedia
High frequency ventilation is a type of mechanical ventilation
that employs very high respiratory rate
s (>150 (Vf) breaths per minute) and very small tidal volume
s. High frequency ventilation is thought to reduce ventilator-associated lung injury
(VALI), especially in the context of ARDS and acute lung injury
. This is commonly referred to as lung protective ventilation. There are different flavors of High frequency ventilation. Each type has its own unique advantages and disadvantages. The types of HFV are characterized by the delivery system and the type of exhalation phase.
High Frequency Ventilation may be used alone, or in combination with conventional mechanical ventilation. In general, those devices that need conventional mechanical ventilation do not produce the same lung protective effects as those that can operate without tidal breathing. Specifications and capabilities will vary depending on the device manufacturer.
Static factors set in this mode PIP, f, Ti,PEEP
and high-frequency oscillatory ventilation. It has been used to salvage patients with persistent hypoxemia
when on conventional mechanical ventilation or, in some cases, used as a primary modality of ventilatory support from the start.
HFOV — High frequency oscillatory ventilation is used in neonates and adult patient populations to reduce lung injury, or to prevent further lung injury. HFOV is characterized by high respiratory rates between 3.5 to 15 hertz
(210 - 900 breaths per minute) and having both inhalation and exhalation maintained by active pressures. The rates used vary widely depending upon patient size, age, and disease process. In HFOV the pressure oscillates around the constant distending pressure (equivalent to Mean Airway Pressure [MAP]) which in effect is the same as Positive End-Expiratory Pressure
(PEEP). Thus gas is pushed into the lung during inspiration, and then pulled out during expiration. HFOV generates very low tidal volumes that are generally less than the dead space of the lung. Tidal volume is dependent on endotracheal tube size, power and frequency. Different mechanisms (Direct Bulk Flow - convective, Taylorian dispersion, Pendelluft effect, Asymmetrical velocity profiles, Cardiogenic mixing and Molecular diffusion) of gas transfer are believed to come into play in HFOV compared to normal mechanical ventilation. It is often used in patients who have refractory hypoxemia that cannot be corrected by normal mechanical ventilation such as is the case in the following disease processes: severe ARDS, ALI and other oxygenation diffusion issues. In some neonatal patients HFOV may be used as the first-line ventilator due to the high susceptibility of the premature infant to lung injury from conventional ventilation.
Breath delivery
The vibrations are created by an electromagnetic valve that controls a piston. The resulting vibrations are similar to those produced by a stereo speaker. The height of the vibrational wave is the amplitude. Higher amplitudes create greater pressure fluctuations which move more gas with each vibration. The number of vibrations per minute is the frequency. One Hertz equals 60 cycles per minute. The higher amplitudes at lower frequencies will cause the greatest fluctuation in pressure and move the most gas.
Altering the % Inspiratory Time (T%i) changes the proportion of the time in which the vibration or sound wave is above the baseline versus below it. Increasing the % Inspiratory Time will also increase the volume of gas moved or tidal volume. Decreasing the frequency, increasing the amplitude, and increasing the % inspiratory time will all increase tidal volume and eliminate CO2. Increasing the tidal volume will also tend to increase the mean airway pressure.
Mechanical ventilation
In medicine, mechanical ventilation is a method to mechanically assist or replace spontaneous breathing. This may involve a machine called a ventilator or the breathing may be assisted by a physician, respiratory therapist or other suitable person compressing a bag or set of bellows...
that employs very high respiratory rate
Respiratory rate
Respiratory rate is also known by respiration rate, pulmonary ventilation rate, ventilation rate, or breathing frequency is the number of breaths taken within a set amount of time, typically 60 seconds....
s (>150 (Vf) breaths per minute) and very small tidal volume
Tidal volume
Tidal volume is the lung volume representing the normal volume of air displaced between normal inspiration and expiration when extra effort is not applied.Typical values are around 500ml or 7ml/kg bodyweight.-Mechanical Ventilation:...
s. High frequency ventilation is thought to reduce ventilator-associated lung injury
Ventilator-associated lung injury
Ventilator-associated lung injury is an acute lung injury that develops during mechanical ventilation and is termed ventilator-induced lung injury if it can be proven that the mechanical ventilation caused the acute lung injury. In contrast, ventilator-associated lung injury exists if the cause...
(VALI), especially in the context of ARDS and acute lung injury
Acute lung injury
Acute lung injury is a diffuse heterogeneous lung injury characterized by hypoxemia, non cardiogenic pulmonary edema, low lung compliance and widespread capillary leakage...
. This is commonly referred to as lung protective ventilation. There are different flavors of High frequency ventilation. Each type has its own unique advantages and disadvantages. The types of HFV are characterized by the delivery system and the type of exhalation phase.
High Frequency Ventilation may be used alone, or in combination with conventional mechanical ventilation. In general, those devices that need conventional mechanical ventilation do not produce the same lung protective effects as those that can operate without tidal breathing. Specifications and capabilities will vary depending on the device manufacturer.
High Frequency Jet Ventilation
HFJV — High frequency jet ventilation employs an endotracheal tube adaptor in place for the normal 15 mm ET tube adaptor. A high pressure ‘’jet’’ of gas flows out of the adaptor and into the airway. This jet of gas occurs for a very brief duration, about 0.02 seconds, and at high frequency: 4-11 hertz. Tidal volumes ≤ 1 ml/Kg are used during HFJV. This combination of small tidal volumes delivered for very short periods of time create the lowest possible distal airway and alveolar pressures produced by a mechanical ventilator. Exhalation is passive. Jet ventilators utilize various I:E ratios—between 1:1.1 and 1:12—to help achieve optimal exhalation. Conventional mechanical breaths are sometimes used to aid in reinflating the lung. Optimal PEEP is used to maintain alveolar inflation and promote ventilation-to-perfusion matching. Jet ventilation has been shown to reduce ventilator induced lung injury by as much as 20%. Usage of high frequency jet ventilation is recommended in neonates and adults with severe lung injury.Static factors set in this mode PIP, f, Ti,PEEP
High Frequency Percussive Ventilation
HFPV — High frequency percussive ventilation combines HFV plus time cycled, pressure-limited controlled mechanical ventilation (i.e., pressure control ventilation, PCV).High Frequency Positive Pressure Ventilation
HFPPV — High frequency positive pressure ventilation is rarely used anymore, having been replaced by High Frequency Jet, Oscillatory and Percussive types of ventilation. HFPPV is delivered through the endotracheal tube using a conventional ventilator whose frequency is set near its upper limits. HFPV began to be used in selected centres in the 1980s. It is a hybrid of conventional mechanical ventilationMechanical ventilation
In medicine, mechanical ventilation is a method to mechanically assist or replace spontaneous breathing. This may involve a machine called a ventilator or the breathing may be assisted by a physician, respiratory therapist or other suitable person compressing a bag or set of bellows...
and high-frequency oscillatory ventilation. It has been used to salvage patients with persistent hypoxemia
Hypoxemia
Hypoxemia is generally defined as decreased partial pressure of oxygen in blood, sometimes specifically as less than or causing hemoglobin oxygen saturation of less than 90%.-Distinction from anemia and hypoxia:...
when on conventional mechanical ventilation or, in some cases, used as a primary modality of ventilatory support from the start.
High Frequency Flow Interruption
HFFI — High Frequency Flow Interruption is similar to high frequency jet ventilation but the gas control mechanism is different. Frequently a rotating bar or ball with a small opening is placed in the path of a high pressure gas. As the bar or ball rotates and the opening lines-up with the gas flow, a small, brief pulse of gas is allowed to enter the airway. Frequencies for HFFI are typically limited to maximum of about 15 hertz.High Frequency Ventilation (Active)
High Frequency Ventilation (Active) — HFV-A is notable for the active exhalation mechanic included. Active exhalation means a negative pressure is applied to force volume out of the lungs.High Frequency Oscillatory Ventilation
Hertz
The hertz is the SI unit of frequency defined as the number of cycles per second of a periodic phenomenon. One of its most common uses is the description of the sine wave, particularly those used in radio and audio applications....
(210 - 900 breaths per minute) and having both inhalation and exhalation maintained by active pressures. The rates used vary widely depending upon patient size, age, and disease process. In HFOV the pressure oscillates around the constant distending pressure (equivalent to Mean Airway Pressure [MAP]) which in effect is the same as Positive End-Expiratory Pressure
Positive end-expiratory pressure
Positive end-expiratory pressure is the pressure in the lungs above atmospheric pressure that exists at the end of expiration...
(PEEP). Thus gas is pushed into the lung during inspiration, and then pulled out during expiration. HFOV generates very low tidal volumes that are generally less than the dead space of the lung. Tidal volume is dependent on endotracheal tube size, power and frequency. Different mechanisms (Direct Bulk Flow - convective, Taylorian dispersion, Pendelluft effect, Asymmetrical velocity profiles, Cardiogenic mixing and Molecular diffusion) of gas transfer are believed to come into play in HFOV compared to normal mechanical ventilation. It is often used in patients who have refractory hypoxemia that cannot be corrected by normal mechanical ventilation such as is the case in the following disease processes: severe ARDS, ALI and other oxygenation diffusion issues. In some neonatal patients HFOV may be used as the first-line ventilator due to the high susceptibility of the premature infant to lung injury from conventional ventilation.
Breath delivery
The vibrations are created by an electromagnetic valve that controls a piston. The resulting vibrations are similar to those produced by a stereo speaker. The height of the vibrational wave is the amplitude. Higher amplitudes create greater pressure fluctuations which move more gas with each vibration. The number of vibrations per minute is the frequency. One Hertz equals 60 cycles per minute. The higher amplitudes at lower frequencies will cause the greatest fluctuation in pressure and move the most gas.
Altering the % Inspiratory Time (T%i) changes the proportion of the time in which the vibration or sound wave is above the baseline versus below it. Increasing the % Inspiratory Time will also increase the volume of gas moved or tidal volume. Decreasing the frequency, increasing the amplitude, and increasing the % inspiratory time will all increase tidal volume and eliminate CO2. Increasing the tidal volume will also tend to increase the mean airway pressure.
Settings and measurements
- T% i — The percent-inspiratory-time changes the percentage of the piston cycle positive pressure is being applied.
- Hz — Hertz (Hz) is the frequency (f) of cycles. One hertz is equal to 60 breaths per minute.
- Δp — The deltap is managed by changing the amplitude. This changes the difference in pressure and controls the mean airway pressure (MAP).