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Am J Perinatol 2018; 35(06): 545-548
DOI: 10.1055/s-0038-1637763
Review Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

New Ventilator Strategies: High-Frequency Oscillatory Ventilation Combined with Volume Guarantee

M. Sánchez-Luna
1   Division of Neonatology, Instituto de Investigación Sanitaria Gregorio Marañón, Complutense University of Madrid, Hospital General Universitario “Gregorio Marañón,” Madrid, Spain
,
N. González-Pacheco
1   Division of Neonatology, Instituto de Investigación Sanitaria Gregorio Marañón, Complutense University of Madrid, Hospital General Universitario “Gregorio Marañón,” Madrid, Spain
,
J. Belik
2   Division of Neonatology, Department of Pediatrics, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
,
M. Santos
3   Medical and Surgical Research Unit, Instituto de Investigación Sanitaria Puerta de Hierro Majadahonda, Hospital Universitario Puerta de Hierro Majadahonda, Majadahonda, Madrid, Spain
,
F. Tendillo
3   Medical and Surgical Research Unit, Instituto de Investigación Sanitaria Puerta de Hierro Majadahonda, Hospital Universitario Puerta de Hierro Majadahonda, Majadahonda, Madrid, Spain
› Author Affiliations Funding Some of these studies were possible due to the grant by the Carlos III Instituto de Salud (FIS 14/00149).
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Publication History

Publication Date:
25 April 2018 (online)

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Abstract

High-frequency oscillatory ventilation (HFOV) has been proposed as an alternative method of invasive ventilation in immature infants to prevent ventilator lung injury. To better control the size of the high-frequency tidal volume and to prevent large tidal volumes, a new strategy of controlling the tidal volume during HFOV (VThf) has been developed, HFOV–volume guarantee (VG). Data from preclinical, neonatal animal studies in normal and surfactant-depleted lungs have demonstrated the feasibility of this technique to directly control the VThf in the normal compliance and low compliance situations. Different I:E ratios also can modify the effect of CO2 washout during HFOV combined with VG in a different way as without the VG modality. Finally, clinical use of this technique in newborn infants has demonstrated the possibility of using very high frequency combined with constant very low VThf to decrease the risk of lung trauma related to the ventilator.

Keywords

high-frequency oscillatory ventilation - volume guarantee ventilation - gas exchange - newborn ventilation - respiratory distress syndrome
 

  • References

  • 1 Slutsky AS, Drazen FM, Ingram Jr RH. , et al. Effective pulmonary ventilation with small-volume oscillations at high frequency. Science 1980; 209 (4456): 609-671
    CrossrefPubMedGoogle Scholar
  • 2 Clark RH, Gerstmann DR, Null Jr DM, deLemos RA. Prospective randomized comparison of high-frequency oscillatory and conventional ventilation in respiratory distress syndrome. Pediatrics 1992; 89 (01) 5-12
    PubMedGoogle Scholar
  • 3 Klingenberg C, Wheeler KI, Davis PG, Morley CJ. A practical guide to neonatal volume guarantee ventilation. J Perinatol 2011; 31 (09) 575-585
    CrossrefPubMedGoogle Scholar
  • 4 Rossing TH, Slutsky AS, Lehr JL, Drinker PA, Kamm R, Drazen JM. Tidal volume and frequency dependence of carbon dioxide elimination by high-frequency ventilation. N Engl J Med 1981; 305 (23) 1375-1379
    CrossrefPubMedGoogle Scholar
  • 5 Slutsky AS, Kamm RD, Rossing TH. , et al. Effects of frequency, tidal volume, and lung volume on CO2 elimination in dogs by high frequency (2-30 Hz), low tidal volume ventilation. J Clin Invest 1981; 68 (06) 1475-1484
    CrossrefPubMedGoogle Scholar
  • 6 Schuster DP, Karsch R, Cronin KP. Gas transport during different modes of high-frequency ventilation. Crit Care Med 1986; 14 (01) 5-11
    CrossrefPubMedGoogle Scholar
  • 7 Cools F, Askie LM, Offringa M. , et al; PreVILIG collaboration. Elective high-frequency oscillatory versus conventional ventilation in preterm infants: a systematic review and meta-analysis of individual patients' data. Lancet 2010; 375 (9731): 2082-2091
    CrossrefPubMedGoogle Scholar
  • 8 Dimitriou G, Greenough A, Kavvadia V, Laubscher B, Milner AD. Volume delivery during high frequency oscillation. Arch Dis Child Fetal Neonatal Ed 1998; 78 (02) F148-F150
    CrossrefPubMedGoogle Scholar
  • 9 Sanchez Luna M. Draeger VN500. In: Donn SM, Sinha SK. , eds. Manual of Neonatal Respiratory Care December. 4th ed. New York, NY: Springer; 2017: 381-389
    Google Scholar
  • 10 Zimová-Herknerová M, Plavka R. Expired tidal volumes measured by hot-wire anemometer during high-frequency oscillation in preterm infants. Pediatr Pulmonol 2006; 41 (05) 428-433
    CrossrefPubMedGoogle Scholar
  • 11 Sánchez Luna M, Santos González M, Tendillo Cortijo F. High-frequency oscillatory ventilation combined with volume guarantee in a neonatal animal model of respiratory distress syndrome. Crit Care Res Pract 2013; 2013: 593915
    PubMedGoogle Scholar
  • 12 Mukerji A, Belik J, Sanchez-Luna M. Bringing back the old: time to reevaluate the high-frequency ventilation strategy. J Perinatol 2014; 34 (06) 464-467
    CrossrefPubMedGoogle Scholar
  • 13 Sánchez-Luna M, González-Pacheco N, Santos M. , et al. Effect of the I/E ratio on CO2 removal during high-frequency oscillatory ventilation with volume guarantee in a neonatal animal model of RDS. Eur J Pediatr 2016; 175 (10) 1343-1351
    CrossrefPubMedGoogle Scholar
  • 14 Iscan B, Duman N, Tuzun F, Kumral A, Ozkan H. Impact of volume guarantee on high-frequency oscillatory ventilation in preterm infants: a randomized crossover clinical trial. Neonatology 2015; 108 (04) 277-282
    CrossrefPubMedGoogle Scholar
  • 15 González-Pacheco N, Sánchez-Luna M, Ramos-Navarro C, Navarro-Patiño N, de la Blanca AR. Using very high frequencies with very low lung volumes during high-frequency oscillatory ventilation to protect the immature lung. A pilot study. J Perinatol 2016; 36 (04) 306-310
    CrossrefPubMedGoogle Scholar
  • 16 Jobe AH, Ikegami M. Lung development and function in preterm infants in the surfactant treatment era. Annu Rev Physiol 2000; 62: 825-846
    PubMedGoogle Scholar