Quote from marilynmom
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)
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.
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