High-frequency oscillatory ventilation with volume guarantee: a single-centre experience

Abstract

Objective: High-frequency oscillatory ventilation (HFOV) is widely used in neonatology. The Dräger Babylog VN500 ventilator offers volume-guaranteed HFOV (HFOV-VG) mode when the high-frequency tidal volume (VThf) to be delivered can be set. We investigated how HFOV-VG maintains VThf in the short and longer term and how it affects other ventilator parameters and blood gases.

Methods: We downloaded ~3.2 million seconds (36.7 days) of ventilator data from 17 infants ventilated using HFOV-VG during clinical care with 1 Hz sampling rate. To process and analyse the data, we used the Python computer language.

Results: Overall, the median VThf was 1.93 mL/kg (IQR 1.64-2.45 mL/kg). The difference between set and delivered tidal volume was <0.2 mL/kg for 83% of time. In the individual recordings, the median VThf ranged between 1.44 and 3.31 mL/kg. During HFOV-VG, the VThf varied from 1 second to another, but it was very close to the target value when averaged over 5 min periods. After weight correction, the VThf or the diffusion coefficient of carbon dioxide (DCO₂) showed weak inverse correlation with partial pressure of CO₂(pCO₂) (for VThf, r=-0.162, 95% CI -0.282 to -0.037, p=0.01). Uncorrected values showed no correlation. Of the 53 blood gas measurements taken when VThf was >2.5 mL/kg, there were only six (11%) with a pCO₂ >8 kPa.

Conclusions: During HFOV-VG, the tidal volume of oscillations varies in the short term but is maintained very close to the target over the longer term. VThf or DCO₂ have poor correlation with CO₂ levels but a volume of >2.5 mL/kg VThf is rarely needed.

Keywords: Hfov; Mechanical Ventilation; Neonatology; Volume-targeted Ventilation.