Lost in a Maze
User manual is superficial, with poor translation from German. Nothing useful is available online about this machine. Experts outside Germany are not very familiar. Lack of interest in the end users.
Amplitude, DP, & Posc: Notice the units in which the parameters are displayed.
Diagram
Peak PRESSURE
MAP (Paw)
Trough Pressure
Below MAP
P of [24 3] = 21 is required in this case to actually oscillate the MAP of 13 by 3.12 cmH2O in each cycle.
Impedance [Z]
Impedance is the total opposition that a circuit (tubing, ET and airways) has against a passing oscillatory current (of air flow).
[Z]
A high impedance circuit will result in high Posc [DP], but low gas flow & tidal volume.
Compliance [C]
Stiffer the lungs, the DP generated will be high; Transmission of the DP to alveoli is when [C] is [C] of chest wall or abdomen also contributes in DP size. Level of water in the humidifier bottle inversely alters the compliance the ventilator tubing (circuit). Over-distended lungs have poor compliance.
Frequency [F]
across the ET occurs mainly with I:E ratio of 1:2 rather than 1:1.
Factors influencing the Posc [DP] magnitude (for the same set Amplitude): MAP [Paw]
When MAP is reduced, DP will also decrease to keep the percentage swing (Amplitude) same. Over-distended lungs (due to high Paw) have lower compliance (even if healthy), therefore, they will generate high DP
Turbulence
Convection
Cardiogenic oscillations
Diffusion
Diffusion
Collateral ventilation
Expiratory flow
Inspiratory flow
1) Patient is 1.5 kg, so Tidal Volume per cycle is 71.5 = 4.7 mL/kg. 2) This baby is not getting any benefit of HFOV, in fact he is on super-IMV. 3) This is the advantage of keeping an eye on Vos.
ET size decides the way Frequency changes the Vo (tidal vol. in mL)
MAP 10, DP 50, Insp 33%
COMPLIANCE NORMAL
OVER COMPLIANT LUNG
3.5 ET
3.0 ET
2.5 ET
STIFF LUNG
Frequency
ET 2.5
NORMAL LUNG
SLE 5000
3100A
MVo in L/min
Infrasonic
Babylog8000
MVo in HFOV is independent of frequency in Sophie, Sensormedics 3100A and SLE 5000
12
13
14
15
Drger, SLE 5000 and Sophie support I:E Ratio of 1:1 (Insp Time: 50%)
Effect of I/E ratio on mean alveolar pressure during high-frequency oscillatory ventilation. J. J. Pillow Journal of Applied Physiology July 1999. An in vitro assessment of gas trapping during high frequency oscillation. Jaana A Leipl, Anne Greenough et al 2005 Physiol. Meas. 26 329 Matching Ventilatory Support Strategies to Respiratory Pathophysiology. Anne Greenough, Steven M. Donn. Clin Perinatol 34 (2007) Elsevier
Pdiff = (Pa-Pao)
INSPIRATORY TIME %
Analyze This
Higher frequencies (13-15Hz) Adequate time may not be available for the piston to complete the forward stroke displacement. The piston then will not be completing its full deflection in the inspiration for generating the required peak pressure.
How do these machines tackle the problem of insufficient forward stroke time
Sensormedics 3100A: Insp. time % is never compromised by the machine. Machine may lower the MAP &/or the P delivered. Stephan Sophie: Will not compromise on MAP and Amplitude. Machine increases the insp time % automatically to deliver the P. SLE 5000: Has a fixed I:E Ratio of 1:1,[it has no dial for I:E Ratio]
Red is the quasi-sine wave in Sophie Green is a pure sine wave, for comparison.
Active expiration has still not started.
photo
HFO Seal
Nurses plug it when HFO is started. It seals (disables) a mechanical safety valve through which baby can breath room air, if the ventilator fails completely. This valve will also open (and disturb the HFOV of baby) when ever a negative pressure of minus 6 is generated in ET by the spontaneous breaths or by deep troughs in delta P (high amplitude setting).
Flow limit
Recommended setting is at 2 liters. If the difference between inspiratory and expiratory flow rate is more than 2L/min, then it machine will consider it as ET disconnection or dislodgement and give an alarm. If the ET is very leaky, than set this parameter at a higher limit, to prevent false alarm.