High-frequency ventilation

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High-frequency ventilation
MeSH D006612

High-frequency ventilation is a type of mechanical ventilation which utilizes a respiratory rate greater than four times the normal value [1] (>150 (Vf) breaths per minute) and very small tidal volumes. [2] [3] High frequency ventilation is thought to reduce ventilator-associated lung injury (VALI), especially in the context of ARDS and acute lung injury. [2] This is commonly referred to as lung protective ventilation. [4] There are different types of high-frequency ventilation. [2] 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.

Contents

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.

Physiology

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.[ citation needed ]

Procedure

High-frequency jet ventilation (passive)

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.

HFJV minimizes movement of the thorax and abdomen and facilitates surgical procedures where even slight motion artifact from spontaneous or intermittent positive pressure ventilation may significantly affect the duration and success of the procedure (for example atrial fibrillation ablation). HFJV does NOT allow: setting specific tidal volume, sampling ETCO2 (and because of this, frequent ABGs are required to measure PaCO2). In HFJV a jet is applied with a set driving pressure, followed by passive exhalation for a very short period before the next jet is delivered, creating "auto-PEEP" (called pause pressure by the jet ventilator). [3] The risk of excessive breath-stacking leading to barotrauma and pneumothorax is low but not zero.

In HFJV exhalation is passive (depends on passive lung and chest-wall recoil) whereas in HFOV gas movement is caused by in-and-out movement of the “loudspeaker” oscillator membrane.  Thus in HFOV both inspiration and expiration are actively caused by the oscillator, and passive exhalation is not allowed.

Bunnell LifePulse jet ventilator

The Life Pulse High Frequency Jet Ventilator Bunnell Life Pulse.jpg
The Life Pulse High Frequency Jet Ventilator
Bidirectional Flow During HFJV HFJV Flow.jpg
Bidirectional Flow During HFJV
Inhaled nitric oxide (iNO) delivery with high-frequency jet ventilation Inhaled Nitric Oxide (iNO) Delivery with High-frequency Jet Ventilation (HFJV).jpg
Inhaled nitric oxide (iNO) delivery with high-frequency jet ventilation

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. [5]

Indications for use

The Bunnell Life Pulse High-Frequency Ventilator is indicated for use in ventilating critically ill infants with pulmonary interstitial emphysema (PIE). Infants studied ranged in birth weight from 750 to 3529 grams and in gestation age from 24 to 41 weeks.

The Bunnell Life Pulse High-Frequency Ventilator is also indicated for use in ventilating critically ill infants with respiratory distress syndrome (RDS) complicated by pulmonary air leaks who are, in the opinion of their physicians, failing on conventional ventilation. Infants of this description studied ranged in birth weight from 600 to 3660 grams and in gestational age from 24 to 38 weeks.

Adverse effects

The adverse side effects noted during the use of high-frequency ventilation include those commonly found during the use of conventional positive pressure ventilators. These adverse effects include:

Contraindications

High-frequency jet ventilation is contraindicated in patients requiring tracheal tubes smaller than 2.5 mm ID.

Settings and parameters

Settings that can be adjusted in HFJV include 1) inspiratory time, 2) driving pressure, 3) frequency, 4) FiO2, and 5) humidity.  Increases in FiO2, inspiratory time, and frequency improve oxygenation (by increasing "auto-PEEP" or pause pressure), while an increase in driving pressure and a decrease in frequency improve ventilation.  

Peak inspiratory pressure (PIP)

The peak inspiratory pressure (PIP) window displays the average PIP. During startup a PIP sample is taken with every inhalation cycle and is averaged with all other samples taken over the most recent ten-second period. After regular operation begins, samples are averaged over the most recent twenty-second period.

ΔP (Delta P)

The value displayed in the ΔP (pressure difference) window represents the difference between the PIP value and the PEEP value.

Servo pressure

The servo pressure display indicates the amount of pressure the machine must generate internally in order to achieve the PIP appearing in the servo-display. Its value can range from 0—20 psi (0—137.9 kPa). If the PIP sensed or approximated at the distal tip of the tracheal tube deviates from the desired PIP, the machine automatically generates more or less internal pressure in an attempt to compensate for the change. The servo-pressure display keeps the operator informed.

The servo display is a general clinical indicator of changes in the compliance or resistance of the patient's lungs, as well as loss of lung volume due to tension pneumothorax.

High-frequency oscillatory ventilation

In HFOV the airway is pressurized to a set mean airway pressure (called continuous lung-distending pressure) through an adjustable expiratory valve.  Small pressure oscillations delivered at a very high rate are superimposed by the action of a “loudspeaker” oscillator membrane. HFOV is often used in premature neonates with respiratory distress syndrome who fail to oxygenate appropriately with lung-protective settings of conventional ventilation.  It has also been used in ARDS in adults, but two studies (the OSCAR and OSCILLATE trials) showed negative results for this indication.

Parameters that can be set in HFOV includes the continuous lung-distending pressure, oscillation amplitude and frequency, I:E ratio (positive-oscillation/negative-oscillation ratio), fresh gas flow (called bias flow), and FiO2.  Increases in continuous lung-distending pressure and FiO2 will improve oxygenation.  Increases in amplitude or fresh gas flow and decreases in frequency will improve ventilation.

High-frequency percussive ventilation

HFPV — High-frequency percussive ventilation combines HFV plus time cycled, pressure-limited controlled mechanical ventilation (i.e., pressure control ventilation, PCV).

High-frequency positive pressure ventilation

HFPPV — High-frequency positive pressure ventilation is rarely used anymore, having been replaced by high-frequency jet, oscillatory and percussive types of ventilation. HFPPV is delivered through the endotracheal tube using a conventional ventilator whose frequency is set near its upper limits. HFPV began to be used in selected centres in the 1980s. It is a hybrid of conventional mechanical ventilation and high-frequency oscillatory ventilation. It has been used to salvage patients with persistent hypoxemia when on conventional mechanical ventilation or, in some cases, used as a primary modality of ventilatory support from the start. [6] [7]

High-frequency flow interruption

HFFI — High Frequency Flow Interruption is similar to high-frequency jet ventilation but the gas control mechanism is different. Frequently a rotating bar or ball with a small opening is placed in the path of a high pressure gas. As the bar or ball rotates and the opening lines-up with the gas flow, a small, brief pulse of gas is allowed to enter the airway. Frequencies for HFFI are typically limited to maximum of about 15 hertz.

High-frequency ventilation (active)

High-frequency ventilation (active) — HFV-A is notable for the active exhalation mechanic included. Active exhalation means a negative pressure is applied to force volume out of the lungs. The CareFusion 3100A and 3100B are similar in all aspects except the target patient size. The 3100A is designed for use on patients up to 35 kilograms and the 3100B is designed for use on patients larger than 35 kilograms.

CareFusion 3100A and 3100B

Sensormedics 3100a Oscillatory ventilator HFOV 3100A.jpg
Sensormedics 3100a Oscillatory ventilator
Details of a patient circuit Oscillator 3100A 2012 diagram.jpg
Details of a patient circuit

High-frequency oscillatory ventilation was first described in 1972 [8] and is used in neonates and adult patient populations to reduce lung injury, or to prevent further lung injury. [9] HFOV is characterized by high respiratory rates between 3.5 and 15 hertz (210 - 900 breaths per minute) and having both inhalation and exhalation maintained by active pressures. The rates used vary widely depending upon patient size, age, and disease process. In HFOV the pressure oscillates around the constant distending pressure (equivalent to mean airway pressure [MAP]) which in effect is the same as positive end-expiratory pressure (PEEP). Thus gas is pushed into the lung during inspiration, and then pulled out during expiration. HFOV generates very low tidal volumes that are generally less than the dead space of the lung. Tidal volume is dependent on endotracheal tube size, power and frequency. Different mechanisms (direct bulk flow - convective, Taylorian dispersion, Pendelluft effect, asymmetrical velocity profiles, cardiogenic mixing and molecular diffusion) of gas transfer are believed to come into play in HFOV compared to normal mechanical ventilation. It is often used in patients who have refractory hypoxemia that cannot be corrected by normal mechanical ventilation such as is the case in the following disease processes: severe ARDS, ALI and other oxygenation diffusion issues. In some neonatal patients HFOV may be used as the first-line ventilator due to the high susceptibility of the premature infant to lung injury from conventional ventilation.

Breath delivery

The vibrations are created by an electromagnetic valve that controls a piston. The resulting vibrations are similar to those produced by a stereo speaker. The height of the vibrational wave is the amplitude. Higher amplitudes create greater pressure fluctuations which move more gas with each vibration. The number of vibrations per minute is the frequency. One Hertz equals 60 cycles per minute. The higher amplitudes at lower frequencies will cause the greatest fluctuation in pressure and move the most gas.

Altering the % inspiratory time (T%i) changes the proportion of the time in which the vibration or sound wave is above the baseline versus below it. Increasing the % Inspiratory Time will also increase the volume of gas moved or tidal volume. Decreasing the frequency, increasing the amplitude, and increasing the % inspiratory time will all increase tidal volume and eliminate CO2. Increasing the tidal volume will also tend to increase the mean airway pressure.

Settings and measurements
Bias flow

The bias flow controls and indicates the rate of continuous flow of humidified blended gas through the patient circuit. The control knob is a 15-turn pneumatic valve which increases flow as it is turned.

Mean pressure adjust

The mean pressure adjust setting adjusts the mean airway pressure (PAW) by controlling the resistance of the airway pressure control valve. The mean airway pressure will change and requires the mean pressure adjust to be adjusted when the following settings are changed:

  • Frequency (Hertz)
  •  % Inspiratory time
  • Power and Δp change
  • Piston centering

During high-frequency oscillatory ventilation (HFOV), PAW is the primary variable affecting oxygenation and is set independent of other variables on the oscillator. Because distal airway pressure changes during HFOV are minimal, [10] [11] the PAW during HFOV can be viewed in a manner similar to the PEEP level in conventional ventilation. [12] The optimal PAW can be considered as a compromise between maximal lung recruitment and minimal overdistention.

Mean pressure limit
Drawing of air movement during high frequency oscillation ventilation Drawing of air movement during high frequency oscillation ventilation.png
Drawing of air movement during high frequency oscillation ventilation

The mean pressure limit controls the limit above which proximal PAW cannot be increased by setting the control pressure of the pressure limit valve. The mean pressure limit range is 10-45 cmH2O.

ΔP and amplitude
Tidal volume versus power setting HFOV Tidal volume versus power setting.jpg
Tidal volume versus power setting

The power setting is set as amplitude to establish a measured change of pressure (ΔP). Amplitude/Power is a setting which determines the amount of power that is driving the oscillator piston forward and backward resulting in an air volume (tidal volume) displacement. The effect of the amplitude on the ΔP that it is changed by the displacement of the oscillator piston and hence the oscillatory pressure (ΔP). The power setting interacts with PAW conditions existing within the patient circuit to produce the resulting ΔP.

 % Inspiratory time

The percent of inspiratory time is a setting which determines the percent of cycle time the piston is traveling toward (or at its final inspiratory position). The inspiratory percent range is 30—50%.

Frequency
Tidal volume versus frequency in Hertz HFOV Tidal volume versus frequency hz.jpg
Tidal volume versus frequency in Hertz

The frequency setting is measured in hertz (hz). The control knob is a 10-turn clockwise-increasing potentiometer covering a range of 3 Hz to 15 Hz. The set frequency is displayed on a digital meter on the face of the ventilator. One Hertz is (-/+5%) equal to 1 breath per second, or 60 breaths per minute (e.g., 10 Hz = 600 breaths per minute). Changes in frequency are inversely proportional to the amplitude and thus delivered tidal volume.

Breaths per minute (f)
Oscillation trough pressure

Oscillation trough pressure is the instantaneous pressure within the HFOV circuit following the oscillating piston reaching its complete negative deflection.

Transtracheal jet ventilation

Transtracheal jet ventilation refers to a type of high-frequency ventilation, low tidal volume ventilation provided via a laryngeal catheter by specialized ventilators that are usually only available in the operating room or intensive care unit. This procedure is occasionally employed in the operating room when a difficult airway is anticipated. Such as Treacher Collins syndrome, Robin sequence, head and neck surgery with supraglottic or glottic obstruction). [13] [14] [15] [16]

Adverse effects

The adverse side effects noted during the use of high-frequency ventilation include those commonly found during the use of conventional positive pressure ventilators. These adverse effects include:

See also

Related Research Articles

<span class="mw-page-title-main">Mechanical ventilation</span> Method to mechanically assist or replace spontaneous breathing

Mechanical ventilation or assisted ventilation is the medical term for using a machine called a ventilator to fully or partially provide artificial ventilation. Mechanical ventilation helps move air into and out of the lungs, with the main goal of helping the delivery of oxygen and removal of carbon dioxide. Mechanical ventilation is used for many reasons, including to protect the airway due to mechanical or neurologic cause, to ensure adequate oxygenation, or to remove excess carbon dioxide from the lungs. Various healthcare providers are involved with the use of mechanical ventilation and people who require ventilators are typically monitored in an intensive care unit.

<span class="mw-page-title-main">Acute respiratory distress syndrome</span> Human disease

Acute respiratory distress syndrome (ARDS) is a type of respiratory failure characterized by rapid onset of widespread inflammation in the lungs. Symptoms include shortness of breath (dyspnea), rapid breathing (tachypnea), and bluish skin coloration (cyanosis). For those who survive, a decreased quality of life is common.

<span class="mw-page-title-main">Respiratory arrest</span> Medical condition

Respiratory arrest is a serious medical condition caused by apnea or respiratory dysfunction severe enough that it will not sustain the body. Prolonged apnea refers to a patient who has stopped breathing for a long period of time. If the heart muscle contraction is intact, the condition is known as respiratory arrest. An abrupt stop of pulmonary gas exchange lasting for more than five minutes may permanently damage vital organs, especially the brain. Lack of oxygen to the brain causes loss of consciousness. Brain injury is likely if respiratory arrest goes untreated for more than three minutes, and death is almost certain if more than five minutes.

<span class="mw-page-title-main">Liquid breathing</span> Respiration of oxygen-rich liquid by a normally air-breathing organism

Liquid breathing is a form of respiration in which a normally air-breathing organism breathes an oxygen-rich liquid (such as a perfluorocarbon), rather than breathing air, by selecting a liquid that can hold a large amount of oxygen and is capable of CO2 gas exchange.

<span class="mw-page-title-main">Bag valve mask</span> Hand-held device to provide positive pressure ventilation

A bag valve mask (BVM), sometimes known by the proprietary name Ambu bag or generically as a manual resuscitator or "self-inflating bag", is a hand-held device commonly used to provide positive pressure ventilation to patients who are not breathing or not breathing adequately. The device is a required part of resuscitation kits for trained professionals in out-of-hospital settings (such as ambulance crews) and is also frequently used in hospitals as part of standard equipment found on a crash cart, in emergency rooms or other critical care settings. Underscoring the frequency and prominence of BVM use in the United States, the American Heart Association (AHA) Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiac Care recommend that "all healthcare providers should be familiar with the use of the bag-mask device." Manual resuscitators are also used within the hospital for temporary ventilation of patients dependent on mechanical ventilators when the mechanical ventilator needs to be examined for possible malfunction or when ventilator-dependent patients are transported within the hospital. Two principal types of manual resuscitators exist; one version is self-filling with air, although additional oxygen (O2) can be added but is not necessary for the device to function. The other principal type of manual resuscitator (flow-inflation) is heavily used in non-emergency applications in the operating room to ventilate patients during anesthesia induction and recovery.

<span class="mw-page-title-main">Dual-control modes of ventilation</span>

Dual-control modes of ventilation are auto-regulated pressure-controlled modes of mechanical ventilation with a user-selected tidal volume target. The ventilator adjusts the pressure limit of the next breath as necessary according to the previous breath's measured exhaled tidal volume. Peak airway pressure varies from breath to breath according to changes in the patient's airway resistance and lung compliance.

Permissive hypercapnia is hypercapnia in respiratory insufficient patients in which oxygenation has become so difficult that the optimal mode of mechanical ventilation is not capable of exchanging enough carbon dioxide. Carbon dioxide is a gaseous product of the body's metabolism and is normally expelled through the lungs.

Positive end-expiratory pressure (PEEP) is the pressure in the lungs above atmospheric pressure that exists at the end of expiration. The two types of PEEP are extrinsic PEEP and intrinsic PEEP. Pressure that is applied or increased during an inspiration is termed pressure support.PEEP is a therapeutic parameter set in the ventilator, or a complication of mechanical ventilation with air trapping (auto-PEEP).

Lung compliance, or pulmonary compliance, is a measure of the lung's ability to stretch and expand. In clinical practice it is separated into two different measurements, static compliance and dynamic compliance. Static lung compliance is the change in volume for any given applied pressure. Dynamic lung compliance is the compliance of the lung at any given time during actual movement of air.

Ventilator-associated lung injury (VALI) is an acute lung injury that develops during mechanical ventilation and is termed ventilator-induced lung injury (VILI) if it can be proven that the mechanical ventilation caused the acute lung injury. In contrast, ventilator-associated lung injury (VALI) exists if the cause cannot be proven. VALI is the appropriate term in most situations because it is virtually impossible to prove what actually caused the lung injury in the hospital.

<span class="mw-page-title-main">Airway pressure release ventilation</span> Pressure control mode of mechanical ventilation

Airway pressure release ventilation (APRV) is a pressure control mode of mechanical ventilation that utilizes an inverse ratio ventilation strategy. APRV is an applied continuous positive airway pressure (CPAP) that at a set timed interval releases the applied pressure. Depending on the ventilator manufacturer, it may be referred to as BiVent. This is just as appropriate to use, since the only difference is that the term APRV is copyrighted.

<span class="mw-page-title-main">Liquid ventilator</span> Medical device

A liquid ventilator is similar to a medical ventilator except that it should be able to ensure reliable total liquid ventilation with a breatheable liquid ·. Liquid ventilators are prototypes that may have been used for animal experimentations but experts recommend continued development of a liquid ventilator toward clinical applications.

Modes of mechanical ventilation are one of the most important aspects of the usage of mechanical ventilation. The mode refers to the method of inspiratory support. In general, mode selection is based on clinician familiarity and institutional preferences, since there is a paucity of evidence indicating that the mode affects clinical outcome. The most frequently used forms of volume-limited mechanical ventilation are intermittent mandatory ventilation (IMV) and continuous mandatory ventilation (CMV). There have been substantial changes in the nomenclature of mechanical ventilation over the years, but more recently it has become standardized by many respirology and pulmonology groups. Writing a mode is most proper in all capital letters with a dash between the control variable and the strategy.

ΔP is a mathematical term symbolizing a change (Δ) in pressure (P).

Continuous mandatory ventilation (CMV) is a mode of mechanical ventilation in which breaths are delivered based on set variables. Still used in the operating room, in previous nomenclature, CMV referred to "controlled mechanical ventilation", a mode of ventilation characterized by a ventilator that makes no effort to sense patient breathing effort. In continuous mandatory ventilation, the ventilator can be triggered either by the patient or mechanically by the ventilator. The ventilator is set to deliver a breath according to parameters selected by the operator. "Controlled mechanical ventilation" is an outdated expansion for "CMV"; "continuous mandatory ventilation" is now accepted standard nomenclature for mechanical ventilation. CMV today can assist or control itself dynamically, depending on the transient presence or absence of spontaneous breathing effort. Thus, today's CMV would have been called ACV in older nomenclature, and the original form of CMV is a thing of the past. But despite continual technological improvement over the past half century, CMV may still be uncomfortable for the patient.

Many terms are used in mechanical ventilation, some are specific to brand, model, trademark and mode of mechanical ventilation. There is a standardized nomenclature of mechanical ventilation that is specific about nomenclature related to modes, but not settings and variables.

Inverse ratio ventilation (IRV) is not necessarily a mode of mechanical ventilation though it may be referred to as such. IRV is a strategy of ventilating the lungs in such a way that the amount of time the lungs are in inhalation is greater than the amount of time they are in exhalation, allowing for a constant inflation of the lungs, ensuring they remain "recruited". The primary goal for IRV is improved oxygenation by forcing inspiratory time to be greater than expiratory time increasing the mean airway pressure and potentially improving oxygenation. Normal I:E ratio is 5:6, so forcing the I:E to be 2:1, 3:1, 4:1, is the source of the term for the strategy.

<span class="mw-page-title-main">SensorMedics high-frequency oscillatory ventilator</span>

The SensorMedics High-Frequency Oscillatory Ventilator is a patented high-frequency mechanical ventilator designed and manufactured by SensorMedics Corp. of Yorba Linda, California. After a series of acquisitions, Vyaire Medical, Inc. marketed the product as 3100A/B HFOV Ventilators. Model 3100 received premarket approval from the United States Food and Drug Administration (FDA) in 1991 for treatment of all forms of respiratory failure in neonatal patients. In 1995, it received pre-market approved for Pediatric Application with no upper weight limit for treating selected patients failing on conventional ventilation.

Mean airway pressure typically refers to the mean pressure applied during positive-pressure mechanical ventilation. Mean airway pressure correlates with alveolar ventilation, arterial oxygenation, hemodynamic performance, and barotrauma. It can also match the alveolar pressure if there is no difference between inspiratory and expiratory resistance.

<span class="mw-page-title-main">Pendelluft</span>

Pendelluft refers to the movement of gas between two regions of the lung, usually between regions of differing compliance or airway resistance. Pendelluft is an important physiological concept to take into account during mechanical ventilation, particularly in patients with an open thorax, severe bronchospasm, or with heterogeneous lung compliance. It was first published as a physiological concept in 1956.

References

  1. ↑ BRISCOE WA, FORSTER RE, COMROE JH (1954). "Alveolar ventilation at very low tidal volumes". J Appl Physiol. 7 (1): 27–30. doi:10.1152/jappl.1954.7.1.27. PMID   13174467.
  2. 1 2 3 Krishnan JA, Brower RG (2000). "High-frequency ventilation for acute lung injury and ARDS". Chest. 118 (3): 795–807. doi:10.1378/chest.118.3.795. PMID   10988205. Archived from the original on 2008-10-06.
  3. 1 2 Standiford TJ, Morganroth ML (December 1989). "High-frequency ventilation". Chest. 96 (6): 1380–9. doi:10.1378/chest.96.6.1380. PMID   2510975.
  4. ↑ Bollen CW, Uiterwaal CS, van Vught AJ (February 2006). "Systematic review of determinants of mortality in high-frequency oscillatory ventilation in acute respiratory distress syndrome". Crit Care. 10 (1): R34. doi: 10.1186/cc4824 . PMC   1550858 . PMID   16507163.
  5. ↑ D. P. Schuster; M. Klain; J. V. Snyder (October 1982). "Comparison of high-frequency jet ventilation to conventional ventilation during severe acute respiratory failure in humans". Critical Care Medicine . 10 (10): 625–630. doi:10.1097/00003246-198210000-00001. PMID   6749433.
  6. ↑ Eastman A, Holland D, Higgins J, Smith B, Delagarza J, Olson C, Brakenridge S, Foteh K, Friese R (August 2006). "High-frequency percussive ventilation improves oxygenation in trauma patients with acute respiratory distress syndrome: a retrospective review". American Journal of Surgery. 192 (2): 191–5. doi: 10.1016/j.amjsurg.2006.01.021 . PMID   16860628.
  7. ↑ Rimensberger PC (October 2003). "ICU cornerstone: high-frequency ventilation is here to stay". Critical Care. 7 (5): 342–4. doi: 10.1186/cc2327 . PMC   270713 . PMID   12974963.
  8. ↑ Lunkenheimer PP, Rafflenbeul W, Keller H, Frank I, Dickhut HH, Fuhrmann C (1972). "Application of transtracheal pressure oscillations as a modification of "diffusing respiration"". Br J Anaesth. 44 (6): 627–628. doi: 10.1093/bja/44.6.627 . PMID   5045565.
  9. ↑ P. Fort; C. Farmer; J. Westerman; J. Johannigman; W. Beninati; S. Dolan; S. Derdak (June 1997). "High-frequency oscillatory ventilation for adult respiratory distress syndrome--a pilot study". Critical Care Medicine . 25 (6): 937–947. doi:10.1097/00003246-199706000-00008. PMID   9201044. S2CID   5547914.
  10. ↑ Gerstmann DR, Fouke JM, Winter DC, Taylor AF, deLemos RA (October 1990). "Proximal, tracheal, and alveolar pressures during high-frequency oscillatory ventilation in a normal rabbit model". Pediatric Research . 28 (4): 367–73. doi: 10.1203/00006450-199010000-00013 . PMID   2235135.
  11. ↑ Easley RB, Lancaster CT, Fuld MK, et al. (January 2009). "Total and regional lung volume changes during high-frequency oscillatory ventilation (HFOV) of the normal lung". Respiratory Physiology & Neurobiology . 165 (1): 54–60. doi:10.1016/j.resp.2008.10.010. PMC   2637463 . PMID   18996228.
  12. ↑ Ono K, Koizumi T, Nakagawa R, Yoshikawa S, Otagiri T (2009). "Comparisons of different mean airway pressure settings during high-frequency oscillation in inflammatory response to oleic acid-induced lung injury in rabbits". Journal of Inflammation Research . 2: 21–8. doi: 10.2147/jir.s4491 . PMC   3218723 . PMID   22096349.
  13. ↑ Ravussin P, Bayer-Berger M, Monnier P, Savary M, Freeman J (1987). "Percutaneous transtracheal ventilation for laser endoscopic procedures in infants and small children with laryngeal obstruction: report of two cases". Can J Anaesth. 34 (1): 83–6. doi: 10.1007/BF03007693 . PMID   3829291.
  14. ↑ Benumof JL, Scheller MS (1989). "The importance of transtracheal jet ventilation in the management of the difficult airway". Anesthesiology. 71 (5): 769–78. doi: 10.1097/00000542-198911000-00023 . PMID   2683873.
  15. ↑ Weymuller EA, Pavlin EG, Paugh D, Cummings CW (1987). "Management of difficult airway problems with percutaneous transtracheal ventilation". Ann Otol Rhinol Laryngol. 96 (1 Pt 1): 34–7. doi:10.1177/000348948709600108. PMID   3813383. S2CID   7469272.
  16. ↑ Boyce JR, Peters GE, Carroll WR, Magnuson JS, McCrory A, Boudreaux AM (2005). "Preemptive vessel dilator cricothyrotomy aids in the management of upper airway obstruction". Can J Anaesth. 52 (7): 765–9. doi: 10.1007/BF03016567 . PMID   16103392.
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