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Tidal volume delivery during high-frequency oscillatory ventilation in adults with acute respiratory distress syndrome.
Crit Care Med. 2007 Jun; 35(6):1522-9.CC

Abstract

OBJECTIVE

a) Characterize how ventilator and patient variables affect tidal volume during high-frequency oscillatory ventilation; and b) measure tidal volumes in adults with acute respiratory distress syndrome during high-frequency oscillatory ventilation.

DESIGN

Observational study.

SETTING

Research laboratory and medical intensive care unit.

PATIENTS

Test lung and patients with acute respiratory distress syndrome.

INTERVENTIONS

Using a previously validated hot wire anemometer placed in series with a Sensormedics 3100B high-frequency ventilator, an endotracheal tube, and a test lung, tidal volume was measured at different combinations of frequency (4, 6, 8, 10, and 12 Hz), pressure amplitude (50, 60, 70, 80, and 90 cm H2O), mean airway pressure (20, 30, and 40 cm H2O), test lung compliance (10, 30, and 50 mL/cm H2O), endotracheal tube internal diameter (6, 7, and 8 mm), bias flow (20, 30, and 40 L/min), and inspiratory/expiratory ratio (1:2 and 1:1). In patients, tidal volume was measured at baseline ventilator settings and at baseline frequency +/-2 Hz and baseline pressure amplitude +/-10 cm H2O.

MEASUREMENTS AND MAIN RESULTS

Measured tidal volumes were 23-225 mL during high-frequency oscillatory ventilation of the test lung. A 2-Hz increase in frequency and a 10-cm H2O increase in pressure amplitude caused a 21.3% +/- 4.1% decrease and 21.4% +/- 3.4% increase in tidal volume, respectively. Decreasing endotracheal tube internal diameter from 8 mm to 7 mm and from 7 mm to 6 mm caused a 15.3% +/- 1.7% and 18.9% +/- 2.1% reduction in tidal volume, respectively. Increasing bias flow from 20 L/min to 30 L/min increased tidal volume by 11.2% +/- 3.9%. Further increases in bias flow, changes in compliance, and changes in mean airway pressure had little effect. Tidal volumes measured in acute respiratory distress syndrome patients were 44-210 mL. A 2-Hz increase in frequency was associated with a 23.1% +/- 6.3% decrease in tidal volume. In contrast to the test lung data, a 10-cm H2O increase in pressure amplitude resulted in only a 5.6% +/- 4.5% increase in tidal volume.

CONCLUSIONS

Tidal volumes are not uniformly small during high-frequency oscillatory ventilation. The primary determinant of tidal volume in adults with acute respiratory distress syndrome during high-frequency oscillatory ventilation with the Sensormedics 3100B is frequency. Test lung findings suggest that endotracheal tube internal diameter is also an important determinant of tidal volume.

Authors+Show Affiliations

Pulmonary and Critical Care Medicine, Johns Hopkins University, Baltimore, MD, USA. dhager1@jhmi.eduNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

17440422

Citation

Hager, David N., et al. "Tidal Volume Delivery During High-frequency Oscillatory Ventilation in Adults With Acute Respiratory Distress Syndrome." Critical Care Medicine, vol. 35, no. 6, 2007, pp. 1522-9.
Hager DN, Fessler HE, Kaczka DW, et al. Tidal volume delivery during high-frequency oscillatory ventilation in adults with acute respiratory distress syndrome. Crit Care Med. 2007;35(6):1522-9.
Hager, D. N., Fessler, H. E., Kaczka, D. W., Shanholtz, C. B., Fuld, M. K., Simon, B. A., & Brower, R. G. (2007). Tidal volume delivery during high-frequency oscillatory ventilation in adults with acute respiratory distress syndrome. Critical Care Medicine, 35(6), 1522-9.
Hager DN, et al. Tidal Volume Delivery During High-frequency Oscillatory Ventilation in Adults With Acute Respiratory Distress Syndrome. Crit Care Med. 2007;35(6):1522-9. PubMed PMID: 17440422.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Tidal volume delivery during high-frequency oscillatory ventilation in adults with acute respiratory distress syndrome. AU - Hager,David N, AU - Fessler,Henry E, AU - Kaczka,David W, AU - Shanholtz,Carl B, AU - Fuld,Mathew K, AU - Simon,Brett A, AU - Brower,Roy G, PY - 2007/4/19/pubmed PY - 2007/7/3/medline PY - 2007/4/19/entrez SP - 1522 EP - 9 JF - Critical care medicine JO - Crit Care Med VL - 35 IS - 6 N2 - OBJECTIVE: a) Characterize how ventilator and patient variables affect tidal volume during high-frequency oscillatory ventilation; and b) measure tidal volumes in adults with acute respiratory distress syndrome during high-frequency oscillatory ventilation. DESIGN: Observational study. SETTING: Research laboratory and medical intensive care unit. PATIENTS: Test lung and patients with acute respiratory distress syndrome. INTERVENTIONS: Using a previously validated hot wire anemometer placed in series with a Sensormedics 3100B high-frequency ventilator, an endotracheal tube, and a test lung, tidal volume was measured at different combinations of frequency (4, 6, 8, 10, and 12 Hz), pressure amplitude (50, 60, 70, 80, and 90 cm H2O), mean airway pressure (20, 30, and 40 cm H2O), test lung compliance (10, 30, and 50 mL/cm H2O), endotracheal tube internal diameter (6, 7, and 8 mm), bias flow (20, 30, and 40 L/min), and inspiratory/expiratory ratio (1:2 and 1:1). In patients, tidal volume was measured at baseline ventilator settings and at baseline frequency +/-2 Hz and baseline pressure amplitude +/-10 cm H2O. MEASUREMENTS AND MAIN RESULTS: Measured tidal volumes were 23-225 mL during high-frequency oscillatory ventilation of the test lung. A 2-Hz increase in frequency and a 10-cm H2O increase in pressure amplitude caused a 21.3% +/- 4.1% decrease and 21.4% +/- 3.4% increase in tidal volume, respectively. Decreasing endotracheal tube internal diameter from 8 mm to 7 mm and from 7 mm to 6 mm caused a 15.3% +/- 1.7% and 18.9% +/- 2.1% reduction in tidal volume, respectively. Increasing bias flow from 20 L/min to 30 L/min increased tidal volume by 11.2% +/- 3.9%. Further increases in bias flow, changes in compliance, and changes in mean airway pressure had little effect. Tidal volumes measured in acute respiratory distress syndrome patients were 44-210 mL. A 2-Hz increase in frequency was associated with a 23.1% +/- 6.3% decrease in tidal volume. In contrast to the test lung data, a 10-cm H2O increase in pressure amplitude resulted in only a 5.6% +/- 4.5% increase in tidal volume. CONCLUSIONS: Tidal volumes are not uniformly small during high-frequency oscillatory ventilation. The primary determinant of tidal volume in adults with acute respiratory distress syndrome during high-frequency oscillatory ventilation with the Sensormedics 3100B is frequency. Test lung findings suggest that endotracheal tube internal diameter is also an important determinant of tidal volume. SN - 0090-3493 UR - https://www.unboundmedicine.com/medline/citation/17440422/Tidal_volume_delivery_during_high_frequency_oscillatory_ventilation_in_adults_with_acute_respiratory_distress_syndrome_ L2 - https://dx.doi.org/10.1097/01.CCM.0000266586.04676.55 DB - PRIME DP - Unbound Medicine ER -