Neo Advanced Ventilation

Question 1

How many breaths per minute are in 1 Hz?

Answer 1

1Hz = 60 breaths per minute

Question 2

Initial HFOV settings?

Answer 2

▪ bias flow → 12 L/min to 15 L/min

▪ frequency (f) in Hz → 8 Hz to 15 Hz based on weight

▪ MAP → 2 cmH2O + MAP on conventional ventilator

▪ FiO2 → 20% + FiO2 on conventional ventilator

▪ Amplitude (ΔP) → 20 cmH2O, adjust for adequate wiggle (only indication that the
airway is patent)

▪ Ti% → 33%

Question 3

In HFOV, what is the only indication that the airway is patent?

Answer 3

Adequate chest wiggle

Question 4

What kind of relationship does frequency and volume have in this HFOV ventilation?

Answer 4

An inverse relationship. The lower the frequency, the greater the volume displaced (the opposite of conventional ventilation)

Question 5

How would you increase oxygenation in HFOV?

Answer 5

• Increase MAP
• Increase FiO2
• Increase Ti%

Question 6

How would you increase ventilation in HFOV?

Answer 6

• Decrease frequency
• Decrease amplitude
• Increase Ti%

Question 7

Weaning HFOV?

Answer 7

Wean FiO2 to 0.6, than wean MAP

• Wean amplitude (not lower than 16cmH2O), than Frequency

Question 8

HFJV Initial settings

Answer 8

▪ tidal volume → 1 mL/kg

▪ f → 240 insufflations/min to 660 insufflations/min

▪ Ti → 0.02 seconds to 0.03 seconds

Question 9

When would you use HFJV

Answer 9

Air leak syndromes

• Involves high velocity inspiration + passive exhalation

Question 10

Phase variables for HFV

Answer 10

▪ Trigger → time
▪ Limit → pressure
▪ Cycle → time

Question 11

How does HFV (jet and o) differ from conventional ventilation

Answer 11

Uses high frequencies + smaller tidal volumes

• pressures at the alveolar are lower than that delivered in conventional but MAP are higher.

Question 12

If MAPs are higher and alveolar pressures are lower with HFV, what advantages does this grand hemodynamically speaking?

Answer 12

Minimizes cardiovascular effects of PPV

Question 13

Indications for HFV?

Answer 13

Acute lung injury causing vent and oxygenation failure

• superior to conventional vent in neonates prior to using surfactant/inhaled nitric oxide/lung protective strategies

Question 14

What is sinusoidal gas flow (bias flow)

Answer 14

Continuous flow of gas that circulates through a vent, even when the patient is not actively inhaling or exhaling.

• Primarily used in modes like HFOV or CPAP/BiPAP.
• bulk flow

Question 15

3 key functions of Bias flow

• aka how is bulk flow useful

Answer 15

Allows gas exchange to happen with minimal lung movement

1. Maintains circuit pressure: continuous gas = maintains peep
2. Clears exhaled CO2: flow flip with continuous flow helps flush air out while supplying new flow
3. Facilities triggering of breaths; changes in flow help detect Pt effort

Question 16

When would a baby require intubation if already on CPAP/BiPAP?

Answer 16

CPAP>7 and/or FiO2 >30%

• persistent WOB, tachypnea, grunting
• Poor CBG or CxR

Question 17

When is CPAP discontinuation considered?

Answer 17

If CPAP is +4 or +5 and FiO2 is 21% for 6-24 hours

• check histograms as well, the limit is <10% of the time below 90 for coming off

Question 18

SiPAP targets

Answer 18

• RR 20
• 9/6 (mean 7)
• Rate set based on condition but ranges from 10-20-30
• Thigh 1s
• I:E ranges from 1:3 - 1:1