NDLI: Unloading work of breathing during high-frequency oscillatory ventilation: a bench study

Content Provider	Springer Nature : BioMed Central
Author	van Heerde, Marc Roubik, Karel Kopelent, Vitek Plötz, Frans B Markhorst, Dick G
Abstract	Introduction With the 3100B high-frequency oscillatory ventilator (SensorMedics, Yorba Linda, CA, USA), patients' spontaneous breathing efforts result in a high level of imposed work of breathing (WOB). Therefore, spontaneous breathing often has to be suppressed during high-frequency oscillatory ventilation (HFOV). A demand-flow system was designed to reduce imposed WOB. Methods An external gas flow controller (demand-flow system) accommodates the ventilator fresh gas flow during spontaneous breathing simulation. A control algorithm detects breathing effort and regulates the demand-flow valve. The effectiveness of this system has been evaluated in a bench test. The Campbell diagram and pressure time product (PTP) are used to quantify the imposed workload. Results Using the demand-flow system, imposed WOB is considerably reduced. The demand-flow system reduces inspiratory imposed WOB by 30% to 56% and inspiratory imposed PTP by 38% to 59% compared to continuous fresh gas flow. Expiratory imposed WOB was decreased as well by 12% to 49%. In simulations of shallow to normal breathing for an adult, imposed WOB is 0.5 J l-1 at maximum. Fluctuations in mean airway pressure on account of spontaneous breathing are markedly reduced. Conclusion The use of the demand-flow system during HFOV results in a reduction of both imposed WOB and fluctuation in mean airway pressure. The level of imposed WOB was reduced to the physiological range of WOB. Potentially, this makes maintenance of spontaneous breathing during HFOV possible and easier in a clinical setting. Early initiation of HFOV seems more possible with this system and the possibility of weaning of patients directly on a high-frequency oscillatory ventilator is not excluded either.
Related Links	https://ccforum.biomedcentral.com/counter/pdf/10.1186/cc4968.pdf
Ending Page	7
Page Count	7
Starting Page	1
File Format	HTM / HTML
ISSN	13648535
DOI	10.1186/cc4968
Journal	Critical Care
Issue Number	4
Volume Number	10
Language	English
Publisher	BioMed Central
Publisher Date	2006-07-18
Access Restriction	Open
Subject Keyword	Intensive Critical Care Medicine Emergency Medicine Spontaneous Breathing Oscillatory Ventilation Ventilator Circuit Test Lung Flow Valve
Content Type	Text
Resource Type	Article
Subject	Critical Care and Intensive Care Medicine
Journal Impact Factor	8.8/2023
5-Year Journal Impact Factor	10.4/2023

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