[JazzyRN]

Hey I was wondering if one of you fabulous experienced PICU nurses could give me some information on the Oscillator vent. I've seen pt's on it and I know its the most powerful vent there is, usually last resort with bad gases. Ive never had the patient on an oscillator and I just wanted to find out some more about it. I hear them talk about amplitude, and mean with these vents, im not so sure what that is. I also noticed these patients dont get suctioned often, sometimes just once a day or so and when they do its a big deal. Why do you clamp the ETT when you remove them from the vent? How come that vent shuts off when you disconnect it? What special considerations do you have to take into account, with a pt on the oscillator vs a pt on the conventional vent? Ive been looking for info about it on the net, but its scarce.Any info you have would be really helpful. Thanks!

[faithmd]

There are a few great threads about it in the NICU forum, go there and type oscillator in the search box. I'll go and try to dig up the info I posted about it a while back,

[faithmd]

I cannot seem to find what I wrote, but here is a link to a thread that has a really good explanation of HFV in it.
http://allnurses.com/forums/f33/vent...ght=oscillator

You can also try to search under HFV, HFOV, or HFO

[JazzyRN]

thanx faith!

[sara52g]

just curious- can someone tell me a little more about what are some standard values that you start your oscillators at, or to put it another way, how high would you go on the pressures on your conventional vent before deciding to go to an oscillator. i know this varies with childs age and size, but i'm just looking for a range.

MAP
AMP
Hz
iTime


Thanks

[dawngloves]

Might I post a link here to my favorite respiratory resource?
http://www.geocities.com/ricks_rcp_resources/

[Ventjock]

Originally Posted by sara52g

just curious- can someone tell me a little more about what are some standard values that you start your oscillators at, or to put it another way, how high would you go on the pressures on your conventional vent before deciding to go to an oscillator. i know this varies with childs age and size, but i'm just looking for a range.

MAP
AMP
Hz
iTime


Thanks

.....

[marilynmom]

Good thread!

I have a question--is the oscillator pediatric/neonate specific? I've never seen or hear about it on the adult floors. If it is ped specific-why?

[Ventjock]

Originally Posted by marilynmom

Good thread!

I have a question--is the oscillator pediatric/neonate specific? I've never seen or hear about it on the adult floors. If it is ped specific-why?

it is used in adults as well.

general rules of when to start HFOV:
Fio2 >60% and PEEP >10-14
Unable to maintain Plat <30
MAP on conventional vent is >24
Pt requiring paralysis for oxygenation
(many physicians will try inverse ratio ventilator first, APRV, or biLevel)

to initiate:
Mean Arterial Pressue should be 75 or greater
FiO2 at 100%
MAP should 5cm greater than MAP on conventional vent. Increase MAP by 1-4cm to achieve optimal lung volume. Optimal lung volume is determined by increasing SpO2 while maintaining fio2 or weaning fio2. diaphragm at should be at ~T8/T9 on CXR. (you want a round diaphragm; not flattened)

Maintain MAP while weaning fio2 to <60%.
Inc MAP until Spo2 stabilizes around 88-94% and begin to wean fio2

Follow CXR to assess lung expansion.
If diaphragm is round and between t8-t9 continue to wean fio2.
If diaphragm is flat and greater than t9 wean MAP by 1cm and reassess CXR.

for nurses and RTs:
Ensure adequate intravascular volume and cardiac output
Consider volume loading or initiate inotropic support. as you all may know high intrathoracic pressures can impede venous return and adversely affect cardiac output. Closely monitor HD status (of course )

power/amplitude is the primary control for PaCO2. (this sets the VT)

typical initial frequency settings:
Neo 10-15 Hz
Pedi 7-9 Hz
Adult 5-6 Hz
itime is usually left at 33%

Hz would be preferably be set at the highest possible level, w/o elevating CO2 too much, to protect the lungs b/c repetitive alveolar collapse and reopening of the under-recruited alveoli can result in atelectrauma.

a smaller amplitude is preferred b/c higher amplitudes implicate higher tidal volumes and thus higher distending pressures. Higher airway pressures can cause lung overdistension with gross tissue injury.

lastly:
increase in amp = decrease in CO2
increase in Hz = increase in CO2

lastly if a patient is on max settings and still hypercapnic, a simple trick might be to deflate the cuff on the ETT, this will enable CO2 to escape around the leak.

soon to be RRT

[janfrn]

Excellent tutorial on HFOV, Ventjock! The orientation of new nurses in our unit skips right over HFOV and when we put someone on the oscillator, these "new" nurses (of which we have an unbelievable number these days) don't know anything about why we use it or what their patient is going to do. Then when the kid's pressure tanks, they're stunned. Might I steal your presentation?