High-frequency oscillatory ventilation in adults: Respiratory therapy issues

Higgins, Jason; Estetter, Bob; Holland, Dean; Smith, Brian J; Derdak, Stephen

doi:10.1097/01.ccm.0000155922.78943.2d

Cited by 15 publications

(10 citation statements)

References 17 publications

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“…By ES, secretions from the tracheobronchial tree are cleared, guaranteeing optimal oxygenation and avoiding accumulation of secretions, leading to tube occlusion, increased work of breathing, atelectasis, and pulmonary infections (1)(2)(3)(4)(5)(6)(7). Yet ES may also have adverse effects, such as disturbances in cardiac rhythm, hypoxemia (due to interruption of the mechanical ventilation and subsequently the decay of intrathoracic pressure), microbial contamination of airway and environment, and development of ventilator-associated pneumonia (VAP).…”

mentioning

confidence: 99%

Open and closed endotracheal suction systems in mechanically ventilated intensive care patients: A meta-analysis

Jongerden

Rovers

Grypdonck

et al. 2007

Critical Care Medicine

109

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mentioning

confidence: 99%

Open and closed endotracheal suction systems in mechanically ventilated intensive care patients: A meta-analysis

Jongerden

Rovers

Grypdonck

et al. 2007

Critical Care Medicine

109

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“…Of particular interest is the performance of closed suction catheters during highfrequency oscillatory ventilation (HFOV), because closed suction is generally recommended for patients receiving this ventilation mode (12,13).…”

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The Effects of Closed Endotracheal Suction on Ventilation During Conventional and High-Frequency Oscillatory Ventilation

et al. 2009

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ABSTRACT:In newborn infants, closed endotracheal tube (ETT) suction may reduce associated adverse effects, but it is not clear whether ventilation is maintained during the procedure. We aimed to determine the effect of ETT size, catheter size, and suction pressure on ventilation parameters measured distal to the ETT. Suction was performed on a test lung, ventilated with conventional (CMV) and high-frequency oscillatory ventilation (HFOV) using ETT sizes 2.5-4.0 mm, catheter sizes 5-8 French gauge (Fr), and suction pressures 80 -200 mm Hg. Tracheal and circuit peak inspiratory pressure, positive end-expiratory pressure, and tracheal tidal volume (V T ) were recorded for each suction episode. During both CMV and HFOV, tracheal pressures and V T were considerably reduced by suctioning; this reduction was dependent on the combination of ETT, catheter, and suction pressure. Loss of V T , inflation pressure (CMV), and pressure amplitude (HFOV) occurred primarily with insertion of the catheter, and loss of end-expiratory pressure (CMV) and mean tracheal pressure (HFOV) occurred with the application of suction. Circuit pressures were reduced to lesser degree. We conclude that airway pressures and V T are not maintained during closed endotracheal suction with either CMV or HFOV, and choice of equipment and settings will affect the degree of interruption to ventilation. (Pediatr Res 66: 400-404, 2009) E ndotracheal tube (ETT) suction is performed periodically on infants receiving mechanical ventilation to clear secretions from the ETT and airway. Although necessary, it is associated with adverse effects including atelectasis, hypoxemia, and cardiovascular instability, partly attributable to loss of airway pressure and interruption of ventilation (1-5). Closed suction, performed without disconnection from respiratory support, has been shown to reduce adverse effects (6 -8), but whether ventilation is maintained during closed suction has not been demonstrated in a neonatal population.With adult-sized ETTs, airway pressure has been shown to decrease during closed suction and concerns have been raised about the potential for very large negative airway pressures during the procedure (4,9,10). However only one study has quantified pressure and tidal volume (V T ) changes during closed suction with neonatal equipment (11). Using an in vitro model, a considerable reduction in airway pressures and V T was demonstrated, particularly when a large catheter relative to the ETT was used. However, the authors did not report results using 5 or 7 French gauge (Fr) suction catheters, nor did they measure the effect of varying the suction pressure.Airway pressures during closed suction are influenced by ventilation mode in adult models (4,10), but this effect has not been studied using neonatal ventilators. Of particular interest is the performance of closed suction catheters during highfrequency oscillatory ventilation (HFOV), because closed suction is generally recommended for patients receiving this ventilation mode (12,13).This study ai...

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“…ARDS in patients is rarely and solely a result of surfactant deficiency only. Early institution of HFOV, however, and institution of HFOV in patients with high potential for recruitment is theoretically beneficial to outcome in ARDS [32-34]. The lavage model is easily recruitable and is probably the most comparable experimental ARDS model for early-phase ARDS.…”

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confidence: 99%

Alternative protocol to initiate high-frequency oscillatory ventilation: an experimental study

et al. 2006

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High-frequency oscillatory ventilation in adults: Respiratory therapy issues

Abstract: Respiratory therapy assessment and procedural skills are essential in providing optimal care to adult patients on HFOV.

Cited by 15 publications

References 17 publications

Open and closed endotracheal suction systems in mechanically ventilated intensive care patients: A meta-analysis

Open and closed endotracheal suction systems in mechanically ventilated intensive care patients: A meta-analysis

The Effects of Closed Endotracheal Suction on Ventilation During Conventional and High-Frequency Oscillatory Ventilation

Alternative protocol to initiate high-frequency oscillatory ventilation: an experimental study

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