BACKGROUND: We used a piglet model of respiratory failure to compare cardiopulmonary responses and pathologic effects on the airway mucosa and lung parenchyma of a combination of high frequency ventilation (HFV) and conventional breaths as provided by an electronic high frequency flow interrupter (HFFI) and a pneumatic oscillator (HFO). Unlike the HFFI, the HFO superimposed high frequency pulses on the conventional breaths. MATERIALS & METHODS: Twelve piglets (mean age 9 days, mean weight 2980 g), assigned at random to either ventilator, received lung lavage and 6 hours of ventilation (FIO2 1.0). Five additional piglets of similar characteristics received alternating HFFI and HFO. RESULTS: The combination of CMV and HFV was readily provided by both devices. Successful gas exchange was accomplished without cardiovascular compromise with either the well-known HFFI or the new pneumatic HFO. CONCLUSIONS: Absence of significant airway and lung injury suggests that the ventilatory strategies instituted resulted in alveolar recruitment and lung-volume maintenance. No beneficial effects of high frequency pulses superimposed on conventional breaths were observed in this study, but the unique capability of the pneumatic HFO to oscillate during lung inflations of different magnitudes and duration should be explored further.
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References
1.
CavanaghK.High frequency ventilation of infants: an analysis of the literature. Respir Care1990;35:815–830.
2.
Product literature. Infant Star Neonatal High Frequency Ventilator. San Diego CA: Infrasonics Inc.
3.
Product literature. Oscillatron-1 Percussionator. Sand Point ID: Percussionaire Corp.
4.
CorderoL, MoranP, LichtensteigerM, TallmanR.Comparison of a high frequency pneumatic oscillator and a magnetic flow interrupter in a piglet model (abstract). Pediatr Res1991;4:311A.
5.
WiswellTE, BleyJA. Ventilation of surfactant-deficient rabbits with a revolutionary pneumatic high frequency oscillatory ventilator compared with conventional mechanical ventilation (abstract). Pediatr Res1991;4:335A.
6.
ByfordLJ, FinklerJH, FroeseAB. Lung volume recruitment during high-frequency oscillation in atelectasis-prone rabbits. J Appl Physiol1988;65:1607–1614.
7.
WatanabeH, KawanoT, KatayamaM, MiyasakaK.Optimal volume recruitment with sustained inflation (SI) during high frequency oscillatory ventilation (HFOV). Proceedings of Conference on High Frequency Ventilation, Snowbird UT, 1991.
8.
CorderoL, TallmanRD, WasielewskiR, NissenC.Comparison of conventional and high-frequency ventilation in piglets after lung lavage. Pediatr Pulmonol1989;6:158–163.
9.
RuizBC, TuckerWK, KirbyRR. A program for calculation of intrapulmonary shunts, blood gas and acid-base values with a programmable calculator. Anesthesiology1985;42:88–95.
10.
DavisK, HurstJM, BransonRD. High frequency percussive ventilation. Probl Respir Care1989;2:39–47.
11.
LachmanB, RobertsonB, VogelJ.In vivo lung lavage as an experimental model of the respiratory distress syndrome. Acta Anaesthesiol Scand1980;24:231–236.
12.
CorderoL, TallmanRD, QualmanS, NissenC.Necrotizing tracheobronchitis following high-frequency ventilation: effect of lung deflation. Pediatr Pathol1988;8:525–533.
13.
McCullochPR, ForkertPG, FroeseAB. Lung volume maintenance prevents lung injury during high frequency oscillatory ventilation in surfactant-deficient rabbits. Am Rev Respir Dis1988;137:1185–1192.
14.
DavisJM, PennyDP, NotterRH, MetlayL, DickersonB, ShapiroDL. Lung injury in the neonatal piglet caused by hyperoxia and mechanical ventilation. J Appl Physiol1989;67:1007–1012.
15.
FroeseAB, BryanAC. High frequency ventilation. Am Rev Respir Dis1987;135:1363–1374.
16.
deLemosRA, GerstmannDR, ClarkRH, GuajardoA, NullD.High frequency ventilation—the relationship between ventilator design and clinical strategy in the treatment of hyaline membrane disease and its complications: a brief review. Pediatr Pulmonol1987;3:370–372.
17.
BellRE, YoderBA, AckermanNB, NullDM, deLemosRA. Comparison of high frequency ventilation by oscillator, jet, and flow interrupter to standard positive pressure ventilation in oleic acid induced lung injury in dogs (abstract). Crit Care Med1984;12:321.
18.
BoyntonBR, ManninoFL, MeatheEA, KopoticRJ, FriederichsenG.Airway pressure measurement during high frequency oscillatory ventilation. Crit Care Med1984;12:39–43.
19.
AllenJL, FredbergJJ, KeefeDH, FrantzID. Alveolar pressure magnitude and asynchrony during high-frequency oscillations of excised rabbit lungs. Am Rev Respir Dis1985;132:343–349.
20.
BoyntonB.High frequency ventilation in newborn infants. Respir Care1986;31:480–490.
21.
GaylordMS, QuissellBJ, LairME. High-frequency ventilation in the treatment of infants weighing less than 1500 gms with pulmonary interstitial emphysema: a pilot study. Pediatrics1987;79:915–921.
22.
Blum-HoffmanE, KopoticRJ, ManninoFL. High-frequency oscillatory ventilation combined with intermittent mandatory ventilation in critically ill neonates: 3 years of experience. Eur J Pediatr1988;147:392–398.
23.
WalshMC, CarloWA. Sustained inflation during HFOV improves pulmonary mechanics and oxygenation. J Appl Physiol1988;65:368–372.
24.
WiswellTE, BleyJA, TurnerBS, HuntRE, FritzDL. The effect of different high frequency ventilator strategies on the propagation of tracheobronchial histopathologic changes. Pediatrics1990;85:70–78.
