This article requires a subscription to view the full text. If you have a subscription you may use the login form below to view the article. Access to this article can also be purchased.
Abstract
BACKGROUND: High-frequency oscillatory ventilation (HFOV) is widely used in neonatal critical care, and several modern ventilators using different technologies are available to provide HFOV. These devices have different technical characteristics that might interact with patient lung mechanics to influence the effectiveness of ventilation. To verify this, we studied the oscillation transmission of 5 neonatal oscillators in a lung model mimicking the mechanical patterns commonly observed in neonatal practice.
METHODS: This was a benchtop, in vitro, physiological, pragmatic study using a model mimicking airways and lung of a 1-kg preterm neonate and the following patterns: normal (compliance: 1.0 mL/cm H2O, resistance: 50 cm H2O/L/s), restrictive (compliance: 0.3 mL/cm H2O, resistance: 50 cm H2O/L/s), and mixed mechanics (compliance: 0.3 mL/cm H2O, resistance: 250 cm H2O/L/s). Several permutations of HFOV parameters (variable mean airway pressure or amplitude or frequency protocols) were tested. Oscillations were measured with a dedicated pressure transducer validated for use during HFOV, and oscillatory pressure ratio (OPR) was calculated to estimate the oscillation transmission.
RESULTS: Overall OPR (calculated on all experiments) was significantly different between ventilators and the mechanical patterns (both P < .001). Different ventilators and patterns accounted for 35.6% and 20.6% of the variation in oscillation transmission, respectively. Sub-analyses per changing amplitude or frequency protocols and multivariate regressions showed that VN500 (standardized β coefficient [St.β]: 0.548, P < .001) and Fabian HFO (St.β: 0.421, P < .001; adjusted R2: 0.615) provided the best oscillation transmission. Fabian HFO also delivered oscillations with the lowest variability when increasing amplitude.
CONCLUSIONS: In an experimental setting mimicking typical neonatal lung disorders, the oscillation transmission was more dependent on the ventilator model than on the mechanical lung conditions at equal HFOV parameters. Fabian HFO and VN500 provided better oscillation transmission overall, and when increasing amplitude, Fabian HFO delivered oscillations with the lowest variability.
Footnotes
- Correspondence: Daniele De Luca MD PhD, Service de Pédiatrie et Réanimation Néonatale, Hôpital A. Béclère, GHU Paris Saclay, APHP, 157 rue de la Porte de Trivaux, 92140 Clamart, France. E-mail: dm.deluca{at}icloud.com
Supplementary material related to this paper is available at http://rc.rcjournal.com.
Dr De Luca discloses relationships with Getinge, Vyaire, and Medtronic. Drs Centorrino and Dell'Orto disclose relationships with Vyaire. The remaining authors have disclosed no conflicts of interest.
- Copyright © 2022 by Daedalus Enterprises
Pay Per Article - You may access this article (from the computer you are currently using) for 1 day for US$30.00
Regain Access - You can regain access to a recent Pay per Article purchase if your access period has not yet expired.