High Frequency Ventilation
| High frequency ventilation | |
|---|---|
| MeSH | D006612 |
High frequency ventilation is a type of mechanical ventilation which utilizes a respiratory rate greater than 4 times the normal value. (>150 (Vf) breaths per minute) and very small tidal volumes. High frequency ventilation is thought to reduce ventilator-associated lung injury (VALI), especially in the context of ARDS and acute lung injury. This is commonly referred to as lung protective ventilation. There are different types of High frequency ventilation. Each type has its own unique advantages and disadvantages. The types of HFV are characterized by the delivery system and the type of exhalation phase.
High frequency ventilation may be used alone, or in combination with conventional mechanical ventilation. In general, those devices that need conventional mechanical ventilation do not produce the same lung protective effects as those that can operate without tidal breathing. Specifications and capabilities will vary depending on the device manufacturer.
With conventional ventilation where tidal volumes (VT) exceed dead space(VDEAD), gas exchange is largely related to bulk flow of gas to the alveoli. With high frequency ventilation, the tidal volumes used are smaller than anatomical and equipment dead space and therefore alternative mechanisms of gas exchange occur.
In the UK, the Mistral or Monsoon jet ventilator (Acutronic Medical Systems) is most commonly used. In the United States the Bunnell LifePulse jet ventilator is most commonly used.
High frequency jet ventilation (HFJV) is provided by the Bunnell Life Pulse High-Frequency Ventilator. HFJV employs an endotracheal tube adaptor in place for the normal 15 mm ET tube adaptor. A high pressure "jet" of gas flows out of the adaptor and into the airway. This jet of gas occurs for a very brief duration, about 0.02 seconds, and at high frequency: 4-11 hertz. Tidal volumes ≤ 1 ml/Kg are used during HFJV. This combination of small tidal volumes delivered for very short periods of time creates the lowest possible distal airway and alveolar pressures produced by a mechanical ventilator. Exhalation is passive. Jet ventilators utilize various I:E ratios—between 1:1.1 and 1:12—to help achieve optimal exhalation. Conventional mechanical breaths are sometimes used to aid in reinflating the lung. Optimal PEEP is used to maintain alveolar inflation and promote ventilation-to-perfusion matching. Jet ventilation has been shown to reduce ventilator induced lung injury by as much as 20%. Usage of high frequency jet ventilation is recommended in neonates and adults with severe lung injury.
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