السلام عليكم ورحمة الله و بركاته
بسوي ثريد صغير عن HFOV
High-frequency ventilation (HFV)
أتمنى يكون موضوع خفيف لطيف
ومُفيد للجميع. 💛
بسوي ثريد صغير عن HFOV
High-frequency ventilation (HFV)
أتمنى يكون موضوع خفيف لطيف
ومُفيد للجميع. 💛
أول شيء هو عبارة عن
Advance Mode of ventilation.
ونقدر نسوي له تعريف بسيط بثلاث نُقاط :
1-High constant pressure during inhalation and exhalation
1-smaller Vt comparing with conventional
3-Supra physiological Frequency > 60 bpm.
Advance Mode of ventilation.
ونقدر نسوي له تعريف بسيط بثلاث نُقاط :
1-High constant pressure during inhalation and exhalation
1-smaller Vt comparing with conventional
3-Supra physiological Frequency > 60 bpm.
Adavntage of HFOV
1- Smaller Vt :
Limit alveolar overdistension
2- Higher Mean airway pressure :
More alveolar recruitment
3- Constant Pmaw during Insp and Expi :
To prevent Alveolar collapse.
1- Smaller Vt :
Limit alveolar overdistension
2- Higher Mean airway pressure :
More alveolar recruitment
3- Constant Pmaw during Insp and Expi :
To prevent Alveolar collapse.
متى استخدم HFOV !!
أول مشكلة الي هي عبارة عن inadequate Oxygenation.
-PIP > 30-35 cm H20
-Fi02 > 0.60 or the inability to wean
-Paw > 15 cm H2O
-PEEP > 10 cm H20
-Oxygenation index > 13-15
أول مشكلة الي هي عبارة عن inadequate Oxygenation.
-PIP > 30-35 cm H20
-Fi02 > 0.60 or the inability to wean
-Paw > 15 cm H2O
-PEEP > 10 cm H20
-Oxygenation index > 13-15
This Oxygenation Index (OI) :
Gives us an accurate way of measuring the diffusion barrier of the lungs - that is, the ability of the lungs to transfer oxygen from the air we breathe into our blood.
ADVICE
•OI <25: good outcome
•OI 25-40: >40% mortality
•OI >40: Consider ECMO
Gives us an accurate way of measuring the diffusion barrier of the lungs - that is, the ability of the lungs to transfer oxygen from the air we breathe into our blood.
ADVICE
•OI <25: good outcome
•OI 25-40: >40% mortality
•OI >40: Consider ECMO
بنتكلم الححين عن الـ Setting
ببدأ باول نقطه من الـ Setting الي هي
Mean airway pressure (Paw)
أول شيء هو بيعطيني Constant pressure
عشان يسمح لي بـ inflate lunges و يسمح لي بـ holds the alveoli open ف بيصير عندي Gas exchange.
ابداء الاعدادات Paw ف الـHFOV !
تقريباً 5-8
cmH2O greater than convention.
Mean airway pressure (Paw)
أول شيء هو بيعطيني Constant pressure
عشان يسمح لي بـ inflate lunges و يسمح لي بـ holds the alveoli open ف بيصير عندي Gas exchange.
ابداء الاعدادات Paw ف الـHFOV !
تقريباً 5-8
cmH2O greater than convention.
طبعاً جاني مريض ع HFOV وفتحت الاشعة ولقيتها Hyperinflation ف وش من الـ setting بغييره !
The answer is Paw ☑️
Follow CXR's to assess lung expansion.
- If the diaphragm is between 8 and 8½, continue to wean the oxygen.
- If the diaphragm is between 9 and 9½, wean the Paw by 1 cm H20.
Follow CXR's to assess lung expansion.
- If the diaphragm is between 8 and 8½, continue to wean the oxygen.
- If the diaphragm is between 9 and 9½, wean the Paw by 1 cm H20.
نتكلم الححين عن
Amplitude
1-The force created by piston movement
2-Dependent on the power setting
3-Results in ( Chest wiggle )
Amplitude
1-The force created by piston movement
2-Dependent on the power setting
3-Results in ( Chest wiggle )
Chest wiggles:
- If chest wiggles become diminished, it could mean:
• The airway is obstructed.
• The ETT is obstructed.
• If chest wiggles are only present on one side it could indicate:
- ETT has slipped down to the right main bronchus.
- A pneumothorax is present.
- If chest wiggles become diminished, it could mean:
• The airway is obstructed.
• The ETT is obstructed.
• If chest wiggles are only present on one side it could indicate:
- ETT has slipped down to the right main bronchus.
- A pneumothorax is present.
بنتكلم الححين عن Inspiratory Time
•Controls the time for movement of the
piston
1-Increases inspiratory time increase CO2 elimination
2-Increase inspiratory time increases
delivered mPaw
•Controls the time for movement of the
piston
1-Increases inspiratory time increase CO2 elimination
2-Increase inspiratory time increases
delivered mPaw
هل قد سألتك انفسكم ليش position piston لازم تكون ف الـ Center !
طبعاً Ti هو الوقت الي يتحكم لي ف حركة piston و يتحكم لي Co2 elimination and lung recruitment لانه بيزيد لي delivered Paw.
• TI = Forward movement piston
Te = Backward movement piston
• TI = Forward movement piston
Te = Backward movement piston
نتكلم عن اخر نقطة الي هي
Bedside Monitoring
-Patient assessment
1-Chest X-ray
2-Arterial blood gas
3-Chest wiggle factor
Bedside Monitoring
-Patient assessment
1-Chest X-ray
2-Arterial blood gas
3-Chest wiggle factor
-Breath sounds
1-Cannot be heard with HFOV
1-Cannot be heard with HFOV
Suctioning :
Close suction catheter is preferred to prevent de-recruitment.
" Do suctioning when indicated :
• Diminished chest wiggles.
• Decrease 02 saturation.
Close suction catheter is preferred to prevent de-recruitment.
" Do suctioning when indicated :
• Diminished chest wiggles.
• Decrease 02 saturation.
ABG management strategy:
1- Hypercapni:
-Increase Amplitude
-Decrease frequency
-Increase inspiratory time
-Deflate the cuff
2-Hypocapnia
-Increase frequency
-Decrease Amplitude
1- Hypercapni:
-Increase Amplitude
-Decrease frequency
-Increase inspiratory time
-Deflate the cuff
2-Hypocapnia
-Increase frequency
-Decrease Amplitude
Weaning for HFOV
-Wean FiO2 for arterial saturation > 90-88%.
-Once the FiO2 is 60% or <60%:
-Check chest x-ray for appropriate inflation.
-Begin to decrease the Paw in 2-3 increments.
-Wean Delta P in 5 cmH2O increments for appropriate PaCO2.
-Wean FiO2 for arterial saturation > 90-88%.
-Once the FiO2 is 60% or <60%:
-Check chest x-ray for appropriate inflation.
-Begin to decrease the Paw in 2-3 increments.
-Wean Delta P in 5 cmH2O increments for appropriate PaCO2.
Lungs being ventilated by an HFOV!
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