A bench study of inhaled nitric oxide delivery during high frequency percussive ventilation

Branson, Richard D.; Griebel, Jeff; Rodriquez, Dario

doi:10.1002/ppul.23934

Cited by 4 publications

(4 citation statements)

References 13 publications

(26 reference statements)

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“…28 In a study by Branson et al, multiple configurations of a Bronchotron Transport Ventilator and iNO delivery system (INOmax DSIR Plus) showed that the dual gas delivery system of the Bronchotron prevents accurate delivery of iNO, failing to deliver iNO within 30% of the set concentrations. 28 Due to the limited availability of Bronchotrons and their incompatibility with iNO, a therapy commonly utilized in this patient population, many institutions are unable to transfer neonates with CDH who are on HFOV with or without iNO to hospitals that can accommodate advanced treatment such as cannulation onto ECMO. Finally, utility outside of the intensive care unit (ICU) such as in the operating room is limited as the vibrations of the oscillator impair the surgeon's ability to repair the defect and anesthesiologists may be less familiar with this mode of ventilation.…”

Section: Discussionmentioning

confidence: 99%

“…Bronchotron Transport Ventilators can provide similar ventilatory support; however, they are not widely available and have shown to be incompatible with iNO. 28 In a study by Branson et al, multiple configurations of a Bronchotron Transport Ventilator and iNO delivery system (INOmax DSIR Plus) showed that the dual gas delivery system of the Bronchotron prevents accurate delivery of iNO, failing to deliver iNO within 30% of the set concentrations. 28 Due to the limited availability of Bronchotrons and their incompatibility with iNO, a therapy commonly utilized in this patient population, many institutions are unable to transfer neonates with CDH who are on HFOV with or without iNO to hospitals that can accommodate advanced treatment such as cannulation onto ECMO.…”

Section: Discussionmentioning

confidence: 99%

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High-Frequency Positive Pressure Ventilation as Primary Rescue Strategy for Patients with Congenital Diaphragmatic Hernia: A Comparison to High-Frequency Oscillatory Ventilation

et al. 2021

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Objective The aim of this article was to evaluate high-frequency positive pressure ventilation (HFPPV) compared with high-frequency oscillatory ventilation (HFOV) as a rescue ventilation strategy for patients with congenital diaphragmatic hernia (CDH). HFPPV is a pressure-controlled conventional ventilation method utilizing high respiratory rate and low positive end-expiratory pressure. Study Design Seventy-seven patients diagnosed with CDH from January 2005 to September 2019 who were treated with stepwise progression from HFPPV to HFOV versus only HFOV were included. Fisher's exact test and the Kruskal–Wallis test were used to compare outcomes. Results Patients treated with HFPPV + HFOV had higher survival to discharge (80 vs. 50%, p = 0.007) and to surgical intervention (95.6 vs. 68.8%, p = 0.003), with average age at repair 2 days earlier (p = 0.004). Need for extracorporeal membrane oxygenation (p = 0.490), inhaled nitric oxide (p = 0.585), supplemental oxygen (p = 0.341), and pulmonary hypertension medications (p = 0.381) were similar. Conclusion In CDH patients who fail respiratory support with conventional ventilation, HFPPV may be used as an intermediary mode of rescue ventilation prior to HFOV without adverse effects. Key Points

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

High-Frequency Positive Pressure Ventilation as Primary Rescue Strategy for Patients with Congenital Diaphragmatic Hernia: A Comparison to High-Frequency Oscillatory Ventilation

et al. 2021

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“…Elastance and resistance can also be estimated through an external monitor during HFPV with acceptable accuracy (61). It is not possible to precisely deliver inhaled nitric oxide during HFPV (62).…”

Section: Bench Studiesmentioning

confidence: 99%

A narrative review of advanced ventilator modes in the pediatric intensive care unit

Miller¹,

Bartle²,

Feldman³

et al. 2021

Transl Pediatr

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Respiratory failure is a common reason for pediatric intensive care unit admission. The vast majority of children requiring mechanical ventilation can be supported with conventional mechanical ventilation (CMV) but certain cases with refractory hypoxemia or hypercapnia may require more advanced modes of ventilation. This paper discusses what we have learned about the use of advanced ventilator modes [e.g., high-frequency oscillatory ventilation (HFOV), high-frequency percussive ventilation (HFPV), high-frequency jet ventilation (HFJV) airway pressure release ventilation (APRV), and neurally adjusted ventilatory assist (NAVA)] from clinical, animal, and bench studies. The evidence supporting advanced ventilator modes is weak and consists of largely of single center case series, although a few RCTs have been performed. Animal and bench models illustrate the complexities of different modes and the challenges of applying these clinically. Some modes are proprietary to certain ventilators, are expensive, or may only be available at well-resourced centers. Future efforts should include large, multicenter observational, interventional, or adaptive design trials of different rescue modes (e.g., PROSpect trial), evaluate their use during ECMO, and should incorporate assessments through volumetric capnography, electric impedance tomography, and transpulmonary pressure measurements, along with precise reporting of ventilator parameters and physiologic variables.

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“…The aim of this study is to implement a method capable of administering CO 2 to both ventilated and non-ventilated patients. In contrast to other CO 2 administration methods, our method does not generate the entire gas mixture but, instead, supplements the inspired gas with additional CO 2 in proportion to the respiratory gas flow, as illustrated in Figure 1 , drawing inspiration from nitric oxide systems ( 15 ). This approach does therefore not rely on the addition of external reservoirs or multiple gas sources, keeping the necessary modification of the breathing circuit minimal, which is desirable in an intensive care setting.…”

Section: Introductionmentioning

confidence: 99%

High inspired CO2 target accuracy in mechanical ventilation and spontaneous breathing using the Additional CO2 method

Magnusson,

Engström,

Georgiopoulos

et al. 2024

Front. Med.

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IntroductionCerebrovascular reactivity imaging (CVR) is a diagnostic method for assessment of alterations in cerebral blood flow in response to a controlled vascular stimulus. The principal utility is the capacity to evaluate the cerebrovascular reserve, thereby elucidating autoregulatory functioning. In CVR, CO2 gas challenge is the most prevalent method, which elicits a vascular response by alterations in inspired CO2 concentrations. While several systems have been proposed in the literature, only a limited number have been devised to operate in tandem with mechanical ventilation, thus constraining the majority CVR investigations to spontaneously breathing individuals.MethodsWe have developed a new method, denoted Additional CO2, designed to enable CO2 challenge in ventilators. The central idea is the introduction of an additional flow of highly concentrated CO2 into the respiratory circuit, as opposed to administration of the entire gas mixture from a reservoir. By monitoring the main respiratory gas flow emanating from the ventilator, the CO2 concentration in the inspired gas can be manipulated by adjusting the proportion of additional CO2. We evaluated the efficacy of this approach in (1) a ventilator coupled with a test lung and (2) in spontaneously breathing healthy subjects. The method was evaluated by assessment of the precision in attaining target inspired CO2 levels and examination of its performance within a magnetic resonance imaging environment.Results and discussionOur investigations revealed that the Additional CO2 method consistently achieved a high degree of accuracy in reaching target inspired CO2 levels in both mechanical ventilation and spontaneous breathing. We anticipate that these findings will lay the groundwork for a broader implementation of CVR assessments in mechanically ventilated patients.

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A bench study of inhaled nitric oxide delivery during high frequency percussive ventilation

Abstract: The dual gas delivery system of the Bronchotron prevents accurate delivery of INO. The combination of these two devices should be accomplished with caution and vigilance.

Cited by 4 publications

References 13 publications

High-Frequency Positive Pressure Ventilation as Primary Rescue Strategy for Patients with Congenital Diaphragmatic Hernia: A Comparison to High-Frequency Oscillatory Ventilation

High-Frequency Positive Pressure Ventilation as Primary Rescue Strategy for Patients with Congenital Diaphragmatic Hernia: A Comparison to High-Frequency Oscillatory Ventilation

A narrative review of advanced ventilator modes in the pediatric intensive care unit

High inspired CO2 target accuracy in mechanical ventilation and spontaneous breathing using the Additional CO2 method

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