Lung recruitment in neonatal high‐frequency oscillatory ventilation with volume‐guarantee

Abstract

Background and Objectives The optimal lung volume strategy during high‐frequency oscillatory ventilation (HFOV) is reached by performing recruitment maneuvers, usually guided by the response in oxygenation. In animal models, secondary spontaneous change in oscillation pressure amplitude (ΔPhf) associated with a progressive increase in mean airway pressure during HFOV combined with volume guarantee (HFOV‐VG) identifies optimal lung recruitment. The aim of this study was to describe recruitment maneuvers in HFOV‐VG and analyze whether changes in ΔPhf might be an early predictor for lung recruitment in newborn infants with severe respiratory failure. Design and Methods The prospective observational study was done in a tertiary‐level neonatology department. Changes in ΔPhf were analyzed during standardized lung recruitment after initiating early rescue HFOV‐VG in preterm infants with severe respiratory failure. Results Twenty‐seven patients were included, with a median gestational age of 24 weeks (interquartile range [IQR]: 23–25). Recruitment maneuvers were performed, median baseline mean airway pressure (mPaw) was 11 cm H2O (IQR: 10–13), median critical lung opening mPaw during recruitment was 14 cm H2O (IRQ: 12–16), and median optimal mPaw was 12 cm H2O (IQR: 10–14, p < 0.01). Recruitment maneuvers were associated with an improvement in oxygenation (FiO2: 65.0 vs. 45.0, p < 0.01, SpO2/FiO2 ratio: 117 vs. 217, p < 0.01). ΔPhf decreased significantly after lung recruitment (mean amplitude: 23.0 vs. 16.0, p < 0.01). Conclusion In preterm infants with severe respiratory failure, the lung recruitment process can be effectively guided by ΔPhf on HFOV‐VG.

Exploration of the thoracoscopic treatment of esophageal atresia under high-frequency ventilation

“…Due to the use of active expiration with a high-frequency oscillator, the mean airway pressure was maintained at a high level during the whole respiratory cycle and prevented airway collapse during expiration ( 18 , 19 ). Because of the airway pressure, the fistula and peri-esophageal tracheal tissue were more precisely separated during treatment.…”

Respiratory Management of the Preterm Infant: Supporting Evidence-Based Practice at the Bedside

“…Although there is poor evidence regarding the use of HFOV combined with volume guarantee (HFOV-VG) in preterm infants, this strategy seems to improve tidal volume and ventilation stabilization over time, showing better short-term neonatal outcomes. Therefore, HFOV-VG should be suggested during the ventilation of preterm infants, especially in situations with rapid changes in lung mechanics, such as surfactant administration [ 100 , 101 ].…”