Unloading Work of Breathing During High-frequency Oscillatory Ventilation: A Bench Study

Authors: Marc van Heerde, Karel Roubík, Vítek Kopelent, Frans B Plötz, Dick G Markhorst

Citation

van Heerde M, Roubik K, Kopelent V, Plötz FB, Markhorst DG. Unloading Work of Breathing During High-Frequency Oscillatory Ventilation: A Bench Study. Critical Care 2006; 10(4); R103.

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Unloading Work of Breathing During High-frequency Oscillatory Ventilation: A Bench Study

Published in Critical Care

Abstract

Introduction: With the 3100B high-frequency oscillatory ventilator (SensorMedics, Yorba Linda, CA, USA), patients’ spontaneous breathing efforts result in a high level of imposed work of breathing (WOB). Therefore, spontaneous breathing often has to be suppressed during high-frequency oscillatory ventilation (HFOV). A demand-flow system was designed to reduce imposed WOB. Methods: An external gas flow controller (demand-flow system) accommodates the ventilator fresh gas flow during spontaneous breathing simulation. A control algorithm detects breathing effort and regulates the demand-flow valve. The effectiveness of this system has been evaluated in a bench test. The Campbell diagram and pressure time product (PTP) are used to quantify the imposed workload.

Results: Using the demand-flow system, imposed WOB is considerably reduced. The demand-flow system reduces inspiratory imposed WOB by 30% to 56% and inspiratory imposed PTP by  38% to 59% compared to continuous fresh gas flow. Expiratory imposed WOB was decreased as well by 12% to 49%. In simulations of shallow to normal breathing for an adult, imposed WOB is 0.5 J l-1 at maximum. Fluctuations in mean airway pressure on account of spontaneous breathing are markedly reduced. Conclusion: The use of the demand-flow system during HFOV results in a reduction of both imposed WOB and fluctuation in mean airway pressure. The level of imposed WOB was reduced to the physiological range of WOB. Potentially, this makes maintenance of spontaneous breathing during HFOV possible and easier in a clinical setting. Early initiation of HFOV seems more possible with this system and the possibility of weaning of patients directly on a high-frequency oscillatory ventilator is not excluded either.

References

[01] Cereda M, Foti G, Marcora B, Gili M, Giacomini M, Sparacino ME, Pesenti A: Pressure support ventilation in patients with acute lung injury. Crit Care Med 2000, 28:1269-1275.
[02] Putensen C, Mutz NJ, Putensen-Himmer G, Zinserling J: Spontaneous breathing during ventilatory support improves ventilation-perfusion distributions in patients with acute respirátory distress syndrome. Am J Respir Crit Care Med 1999, 159:1241-1248.
[03] Putensen C, Muders T, Varelmann D, Wrigge H: The impact of spontaneous breathing during mechanical ventilation. Curr Opin Crit Care 2006, 12:13-18.
[04] Sydow M, Burchardi H, Ephraim E, Zielmann S, Crozier TA: Longterm effects of two different ventilatory modes on oxygenation in acute lung injury. Comparison of airway pressure release ventilation and volume-controlled inverse ratio ventilation. Am J Respir Crit Care Med 1994, 149:1550-1556.
[05] Wrigge H, Zinserling J, Neumann P, Muders T, Magnusson A, Putensen C, Hedenstierna G: Spontaneous breathing with airway pressure release ventilation favors ventilation in dependent lung regions and counters cyclic alveolar collapse in oleicacid-induced lung injury: a randomized controlled computed tomography trial. Crit Care 2005, 9:R780-R789.
[06] Bollen CW, Uiterwaal CS, van Vught AJ: Cumulative metaanalysis of high-frequency versus conventional ventilation in premature neonates. Am J Respir Crit Care Med 2003, 168:1150-1155.
[07] Froese AB, Kinsella JP: High-frequency oscillatory ventilation: lessons from the neonatal/pediatric experience. Crit Care Med 2005, 33:S115-S121.
[08] Bollen CW, van Well GT, Sherry T, Beale RJ, Shah S, Findlay G, Monchi M, Chiche JD, Weiler N, Uiterwaal CS, van Vught AJ: High frequency oscillatory ventilation compared with conventional mechanical ventilation in adult respiratory distress syndrome: a randomized controlled trial [ISRCTN24242669]. Crit Care 2005, 9:R430-R439.
[09] Derdak S, Mehta S, Stewart TE, Smith T, Rogers M, Buchman TG, Buchman TG, Carlin B, Lowson S, Granton J: High-frequency oscillatory ventilation for acute respiratory distress syndrome in adults: a randomized, controlled trial. Am J Respir Crit Care Med 2002, 166:801-808.
[10] Singh JM, Ferguson ND: Is it time to increase the frequency of use of high-frequency oscillatory ventilation? Crit Care 2005, 9:339-340.
[11] Slee-Wijffels FY, van der Vaart KR, Twisk JW, Markhorst DG, Plotz FB: High-frequency oscillatory ventilation in children: a singlecenter experience of 53 cases. Crit Care 2005, 9:R274-R279.
[12] Pachl J, Roubik K, Waldauf P, Fric M, Zabrodsky V: Normocapnic high-frequency oscillatory ventilation affects differently extrapulmonary and pulmonary forms of acute respiratory distress syndrome in adults. Physiol Res 2006, 55:15-24.
[13] David M, Weiler N, Heinrichs W, Neumann M, Joost T, Markstaller K, Eberle B: High-frequency oscillatory ventilation in adult acute respiratory distress syndrome. Intensive Care Med 2003, 29:1656-1665.
[14] Mehta S, Granton J, MacDonald RJ, Bowman D, Matte-Martyn A, Bachman T, Smith T, Stewart TE: High-frequency oscilátory ventilation in adults: the Toronto experience. Chest 2004, 126:518-527.
[15] Derdak S: High-frequency oscillatory ventilation for acute respiratory distress syndrome in adult patients. Crit Care Med 2003, 31:S317-S323.
[16] van Heerde M, van Genderingen HR, Leenhoven T, Roubik K, Plotz FB, Markhorst DG: Imposed work of breathing during high-frequency oscillatory ventilation: a bench study. Crit Care 2006, 10:R23.
[17] Sessler CN: Sedation, analgesia, and neuromuscular blockade for high-frequency oscillatory ventilation. Crit Care Med 2005, 33:S209-S216.
[18] Banner MJ, Jaeger MJ, Kirby RR: Components of the work of breathing and implications for monitoring ventilator-dependent patients. Crit Care Med 1994, 22:515-523.
[19] Pillow JJ: High-frequency oscillatory ventilation: mechanisms of gas exchange and lung mechanics. Crit Care Med 2005, 33:S135-S141.
[20] IngMar Medical: Operator Instructions ASL 5000 Pittsburg PA: IngMar Medical; 2003.
[21] Campbell EJ: The Respiratory Muscles and the Mechanisms of Breathing Chicago: Year Book Medical; 1958.
[22] Agostini E, Campbell EJ, Freedman S: Energetics. In The Respiratory Muscles Edited by: Campbell EJ, Agostini E, Newsom Davis J. Philedelphia, PA: Saunders; 1970:115-137.
[23. Banner MJ, Downs JB, Kirby RR, Smith RA, Boysen PG, Samsun Lampotang ME: Effects of expiratory flow resistance on inspiratory work of breathing. Chest 1988, 93:795-799.
[24] French CJ: Work of breathing measurement in the critically ill patient. Anaesth Intensive Care 1999, 27:561-573.
[25] Girault C, Breton L, Richard JC, Tamion F, Vandelet P, Aboab J, Leroy J, Bonmarchand G: Mechanical effects of airway humidification devices in difficult to wean patients. Crit Care Med 2003, 31:1306-1311.
[26] MacIntyre NR: Respiratory mechanics in the patient who is weaning from the ventilator. Respir Care 2005, 50:275-286.
[27] MacIntyre NR, Cook DJ, Ely EW Jr, Epstein SK, Fink JB, Heffner JE, Hess D, Hubmayer RD, Scheinhorn DJ: Evidence-based guidelines for weaning and discontinuing ventilatory support: a collective task force facilitated by the American College of Chest Physicians; the American Association for Respiratory Care; and the American College of Critical Care Medicine. Chest 2001, 120:375S-395S.