What do we need before switching to HFOV?

What do we need before switching to HFOV?

Ensure blood pressure and intravascular volume is adequate before transferring to HFOV, as blood pressure may fall rapidly, especially in babies with perfusion problems in Sepsis / NEC. Consider volume expansion to avoid a sharp fall in cardiac output.

What does bias flow do for HFOV?

During high frequency oscillatory ventilation (HFOV), bias flow is the continuous flow of gas responsible for replenishing oxygen and removing carbon dioxide (CO2) from the patient circuit. Bias flow is usually set at 20 liters per minute (lpm), but many patients require neuromuscular blockade (NMB) at this flow rate.

Is HFOV mechanical ventilation?

High frequency oscillatory ventilation (HFOV) is a type of mechanical ventilation that uses a constant distending pressure (mean airway pressure [MAP]) with pressure variations oscillating around the MAP at very high rates (up to 900 cycles per minute).

How do I set up HFOV?

Start at a frequency of 10 Hz and a Power of 3.0 to 5.0 (amplitude/delta P 35-45 cm). Initial MAP 4 cm above MAP while on CMV. Check CXR 1-2 hrs after converting to HFOV, then adjust MAP to achieve optimal lung volume (9 ribs expanded with improved aeration).

When do you use HFOV?

High-frequency oscillatory ventilation (HFOV) is a lung-protective strategy that can be utilized in the full spectrum of patient populations ranging from neonatal to adults with acute lung injury. HFOV is often utilized as a rescue strategy when conventional mechanical ventilation (CV) has failed.

How do you set up HFOV?

How do you wean off HFOV?

Weaning

1. First wean FiO2 until ≤ 0.60 unless hyperinflated.
2. Once FiO2 ≤ 0.60 or hyperinflated, decrease MAP by 1 cm Q4-8h; if OXYGENATION is lost during weaning then increase MAP by 2-4 cm to restore lung volumes and begin weaning again, but proceed more slowly with decreases in MAP.

What is HFOV and why do we need it?

We still don’t know to what extent the different factors damage the lungs, but high pressures (barotrauma), shear stress (large tidal volumes) and high inspired oxygen levels are all culprits. HFOV is a way to reduce maximum pressure, reduce tidal volume and reopen those alveoli, improving oxygenation. So… what is HFOV?

What should be the power setting on HFOV?

After approximately 30 minutes of HFOV, a repeat blood gas should be analyzed and the power setting should be titrated based on the desired Pa co 2 level. The chest wall needs to be vibrating; if not, the power setting has to be increased. On all patients placed on HFOV, it is crucial that oxygen is flowing to the patient.

How do you attach ett to HFOV?

Some people attach directly to the oscillator, but it is probably better to oxygenate using hand ventilation, then clamp the ETT at inspiration, then attach to the HFOV. This avoids de-recruitment. As soon as you are connected and the oscillator running, adjust the amplitude until the chest, abdomen and a bit of the thigh are wobbling.

Is HFOV a useful mode of ventilation during neonatal surgery?

The global clinical impression is that the use of HFOV during neonatal surgery improves surgical comfort and respiratory status compared with conventional ventilation. As neonatal care improves, anesthesiologists will be faced with an increasing number of high-risk neonates and therefore must be familiar with this mode of ventilation.

https://www.youtube.com/watch?v=2CNpvGYwqP8