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Division of Neonatology and Pediatric Critical Care, University Children's Hospital, D-89070 Ulm, Germany
In high-frequency
oscillatory ventilation (HFOV), an adequate mean airway pressure is
crucial for successful ventilation and optimal gas exchange, but air
trapping cannot be detected by the usual measurement at the y piece.
Intratracheal pressures produced by the high-frequency oscillators
HFV-Infantstar (IS), Babylog 8000 (BL), and the SensorMedics 3100A (SM)
[the latter with either 30% (SM30) or 50%
(SM50) inspiratory time] were investigated in four
anesthetized tracheotomized female piglets that were 1 day old and
weighed 1.6-1.9 kg (mean 1.76 kg). The endotracheal tube was
repeatedly clamped while the piglets were ventilated with an
oscillation frequency of 10 Hz, and the airway pressure distal of the
clamp was recorded as a measure of average intrapulmonary pressure
during oscillation. Clamping resulted in a significant decrease of mean
airway pressure when the piglets were ventilated with SM30
(
0.86 cmH2O), BL (
0.66 cmH2O), and IS
(
0.71 cmH2O), but airway pressure increased by a mean of
0.76 cmH2O with SM50. Intratracheal pressure,
when measured by a catheter pressure transducer at various oscillation
frequencies, was lower than at the y piece by 0.4-0.9
cmH2O (SM30), 0.3-3 cmH2O
(BL), and 1-4.7 cmH2O (IS) but was 0.4-0.7
cmH2O higher with SM50. We conclude that the
inspiratory-to-expiratory time
(TI/TE) ratio influences the
intratracheal and intrapulmonary pressures in HFOV and may sustain a
mean pressure gradient between the y piece and the trachea. A
TI/TE ratio < 1:1 may
be useful to avoid air trapping when HFOV is used.
air trapping; mean airway pressure; oscillatory flow; low-pass filter; newborn piglets; inspiratory-to-expiratory time ratio
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