High-Frequency Ventilation

Mammel, Mark C.; Courtney, Sherry E.

doi:10.1016/b978-0-323-39006-4.00022-3

Cited by 3 publications

(3 citation statements)

References 138 publications

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“…The potential advantages of HFOV over conventional ventilation include lower peak airway pressures, the ability to adequately and independently manage oxygenation and ventilation while using very small tidal volumes, and preservation of normal lung architecture even at high mean airway pressures ( 19 ). Therefore, HFOV is also believed to reduce the risk of pulmonary air leaks ( 8 ).…”

Section: Discussionmentioning

confidence: 99%

Association between mean airway pressure during high-frequency oscillatory ventilation and pulmonary air leak in extremely preterm infants during the first week of life

Tamai,

Takeuchi,

Nakamura

et al. 2024

Front. Pediatr.

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BackgroundWhile positive pressure ventilation has been considered an important contributing factor associated with pulmonary air leaks, studies examining the association between specific ventilatory settings during acute-phase high-frequency oscillatory ventilation (HFOV) and pulmonary air leaks among extremely preterm infants are limited.MethodsThis was a single-center retrospective cohort study conducted at an institution that primarily used HFOV after intubation in extremely preterm infants. We analyzed data from extremely preterm infants born between 2010 and 2021. The primary outcome was pulmonary air leakage during the first 7 days of life. The exposure variable was the maximum mean airway pressure (MAP) on HFOV during the first 7 days of life or before the onset of pulmonary air leaks. Maximum MAP was categorized into three groups: low (7–10 cmH2O), moderate (11–12 cmH2O), and high (13–15 cmH2O) MAP categories. We conducted robust Poisson regression analyses after adjustment for perinatal confounders, using the low MAP category as the reference.ResultsThe cohort included 171 infants (low MAP, 123; moderate MAP, 27; and high MAP, 21). The median (interquartile range) gestational age and birth weight were 25.7 (24.3–26.7), 25.7 (24.9–26.9), and 25.3 (24.3–26.6) weeks and 760 (612–878), 756 (648–962), and 734 (578–922) g for infants in the low, moderate, and high MAP categories, respectively. Compared to infants in the low MAP category, those in the high MAP category had a higher incidence of pulmonary air leaks (4.1% vs. 33.3%; adjusted risk ratio, 5.4; 95% confidence interval, 1.6–18.5). In contrast, there was no clear difference in the risk of pulmonary air leaks between the moderate and low MAP categories (3.7% vs. 4.1%; adjusted risk ratio, 0.9; 95% confidence interval, 0.1–6.1).ConclusionExtremely preterm infants requiring high MAP (≥13 cmH2O) in acute-phase HFOV had a higher risk of pulmonary air leak during the first 7 days of life.

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Section: Discussionmentioning

confidence: 99%

Association between mean airway pressure during high-frequency oscillatory ventilation and pulmonary air leak in extremely preterm infants during the first week of life

Tamai,

Takeuchi,

Nakamura

et al. 2024

Front. Pediatr.

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“…Despite this list of mechanisms, little advance has been made in using knowledge of them to be able to quantify or predict the gas transport that will occur. Protocols for the clinical use of HFV, where they exist, have often been derived with minimal evidence [ 32 , 34 , 41 , 45 ].…”

Section: Introductionmentioning

confidence: 99%

The impact of steady streaming and conditional turbulence on gas transport during high-frequency ventilation

Jacob

Tingay

Leontini

2021

Theor. Comput. Fluid Dyn.

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High-frequency ventilation is a type of mechanical ventilation therapy applied on patients with damaged or delicate lungs. However, the transport of oxygen down, and carbon dioxide up, the airway is governed by subtle transport processes which hitherto have been difficult to quantify. We investigate one of these mechanisms in detail, nonlinear mean streaming, and the impact of the onset of turbulence on this streaming, via direct numerical simulations of a model 1:2 bifurcating pipe. This geometry is investigated as a minimal unit of the fractal structure of the airway. We first quantify the amount of gas recirculated via mean streaming by measuring the recirculating flux in both the upper and lower branches of the bifurcation. For conditions modeling the trachea-to-bronchi bifurcation of an infant, we find the recirculating flux is of the order of 3–5% of the peak flux . We also show that for conditions modeling the upper generations, the mean recirculation regions extend a significant distance away from the bifurcation, certainly far enough to recirculate gas between generations. We show that this mean streaming flow is driven by the formation of longitudinal vortices in the flow leaving the bifurcation. Second, we show that conditional turbulence arises in the upper generations of the airway. This turbulence appears only in the flow leaving the bifurcation, and at a point in the cycle centered around the maximum instantaneous flow rate. We hypothesize that its appearance is due to an instability of the longitudinal-vortices structure.

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“…Learners in graduate medical education (GME) frequently view training in MV as insufficient ( 3 – 6 ). Factors leading to variable or absent curricula include ambiguities in curricular specifications from governing bodies; inconsistent ventilator nomenclature ( 7 , 8 ); the high basic science education needed for clinical application ( 9 , 10 ); and, in the neonatal intensive care unit (NICU), the unique neonatal pathophysiology and needs of neonates ( 11 , 12 ). Duty-hour restrictions and varying resident schedules further challenge the delivery of effective, equitable education.…”

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confidence: 99%

A Flipped Classroom Pilot in Neonatal Mechanical Ventilation

Mavis,

Brumbaugh,

Carey

et al. 2024

ATS Scholar

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Background Pediatric residents frequently manage critically ill neonates but have limited systematic training in mechanical ventilation (MV). Competing demands, varying learner levels, and topic complexity contribute to inconsistent education. A blended learning approach may be ideally suited to achieve meaningful learning but has not been described for this topic and learner. Objective To design, implement, and evaluate a flipped classroom for pediatric residents in neonatal MV. Methods We used Kern’s six-step framework for curricular development to create a flipped classroom curriculum in neonatal MV. Individual prework included interaction with six prerecorded animated whiteboard videos, while in-person learning occurred in small groups at the bedside of a ventilated infant. A mixed-methods evaluation included surveys, quantitative knowledge test scores (before, immediately after, and six months after course completion), and qualitative analysis of participant focus groups. Results Twenty-six learners participated in the curriculum. Mean knowledge test scores rose and were sustained after course completion (51% baseline, 82% immediate posttest, 90% retention; P < 0.001). Learners identified various design elements, technology affordances, and instructor factors as meaningful, and they identified unexpected impacts of the curriculum beyond knowledge acquisition, including effects on professional identities, interdisciplinary communication skills, and contribution to the culture of safety. Conclusion This curriculum aligned with resident roles, was meaningful to learners, and led to long-term increases in knowledge scores and access to quality education; flipped classroom design using meaningful learning theory and leveraging animated whiteboard technology may be a useful strategy for other highly complex topics in graduate medical education.

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High-Frequency Ventilation

Cited by 3 publications

References 138 publications

Association between mean airway pressure during high-frequency oscillatory ventilation and pulmonary air leak in extremely preterm infants during the first week of life

Association between mean airway pressure during high-frequency oscillatory ventilation and pulmonary air leak in extremely preterm infants during the first week of life

The impact of steady streaming and conditional turbulence on gas transport during high-frequency ventilation

A Flipped Classroom Pilot in Neonatal Mechanical Ventilation

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