Oscillators

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Specializes in women's health, NICU.

Can someone please explain to me how oscillators work vs. the conventional ventilator? I have seen this and some of the RT's have explained it to me a few times but I am so confused. Hopefully the more times i do see oscillators, the more it will start to make sense to me.:uhoh21:

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Specializes in NICU, Infection Control.

See if this helps: https://content.nejm.org/cgi/content/full/347/9/633.

Also, check in Merenstein and Gardner, chapter 23, p 616.

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Can someone please explain to me how oscillators work vs. the conventional ventilator? I have seen this and some of the RT's have explained it to me a few times but I am so confused. Hopefully the more times i do see oscillators, the more it will start to make sense to me.:uhoh21:

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That is most certainly the million dollar question! Think tiny volumes (1-3 ml/Kilo*) and really high RR. The Vt is usually less then Pt's physiologic dead space, and is set by the MAP (mean AW pressure) and Pip. Exactly how adequate oxygenation and ventilation is achieved is somewhat of a mystery to me, I've read a bit about the subject and the general concencus is the occurance of coaxial flow (resonant frequency). I've seen a rate as high as 15Hz (900 bpm!) While exhalation is passive in the healthy lung (as well as conventional mechanical ventilation) the diaphram on an oscillator will not only deliver the desired volume, it will actively pull it out as well. HFV is part of a PLS (protective lung strategy) because we're dealing with such tiny volumes, we can ventilate with much lower pressures. Check out the following link for a much more detailed description than I'm able to offer.

http://www.chestjournal.org/cgi/content/full/118/3/795

*Egans Fundamentals of Respiratory Care 8th edition.

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I don't understand them completely but an RT offered this same type of info which I found on http://www.neonatology.org.

"Unlike traditional ventilators, which essentially inflate and deflate the baby's lungs like a set of billows, the oscillator keeps the lungs open with a constant positive end-expiratiory pressure ("PEEP") and vibrates the air at a very high rate (up to 600 times per second). The vibration helps gases to quickly diffuse in and out of the baby's airways without the need for the "bellows" action which may damage delicate lung structures. Although oscillators are not appropriate for every disorder and situation, there is no doubt that because of their incredible power, oscillators have made it easeir to care for the very sickest babies with certain types of lung problems."

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Specializes in NICU, Infection Control.

The name of the game is to prevent barotrauma. Hence the increased use of non-invasive ventilation in recent years.

But oscillators were great. Only problem was when the cardiologists come around to do heart ECHOs. One of those wierd heart docs actually asked me to take the baby off the vent b/c he couldn't get decent pictures. Um, no thanks, no CPR today, doc!

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Specializes in ECMO.
The name of the game is to prevent barotrauma. Hence the increased use of non-invasive ventilation in recent years.

But oscillators were great. Only problem was when the cardiologists come around to do heart ECHOs. One of those wierd heart docs actually asked me to take the baby off the vent b/c he couldn't get decent pictures. Um, no thanks, no CPR today, doc!

couldn't you just bag the kiddo REALLY REALLY FAST with super TINY breaths? :chuckle

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Specializes in NICU.

But oscillators were great. Only problem was when the cardiologists come around to do heart ECHOs. One of those wierd heart docs actually asked me to take the baby off the vent b/c he couldn't get decent pictures. Um, no thanks, no CPR today, doc!

Our XRay techs do this too! I'm always unable to explain why this would be a BAD idea because I'm so baffled by the idiocy of the request that I can't speak properly.

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Specializes in NICU, Infection Control.

I forgot to mention that the child was PARALYZED. :angryfire:banghead:

"..couldn't you just bag the kiddo REALLY REALLY FAST with super TINY breaths?.."

Sorry! NO. :wink2:

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The name of the game is to prevent barotrauma. Hence the increased use of non-invasive ventilation in recent years.

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I know this is off topic, but how does the use of NIPPV prevent barotrauma?

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Specializes in NICU.

Nevermind, I'm an idiot. NIPPV does not = the oscillator.

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Specializes in Neonatal ICU (Cardiothoracic).
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I know this is off topic, but how does the use of NIPPV prevent barotrauma?

It doesn't. As long as you have a machine pumping gas in to achieve a set PIP/PEEP, you have the potential for barotrauma. The only advantage is that you can preserve the mucociliary protective barrier in the trachea by not having a ETT.

NCPAP, on the other hand, only keeps the lungs open with a peep of 5, usually. The baby's lungs and respiratory effort determine PIP.

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Specializes in NICU, Infection Control.

That's exactly it.

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