HFPV VDR4 ® Definition: “The VDR® is classified as a pneumatically powered, pressure regulated, time cycled, high frequency flow interrupter.” - Delivers high frequency in a range of 200-900 cycles/min. - Passive exhalation Adel Bougatef MD, PhD. 1 Conv. Pressure Rise Pulse Frequency Pulse i:e Ratio Inspiratory Time Pulsatile Flowrate (PIP) Expiratory Time Osc./Demand CPAP Typicale HFPV waveform i Pressure e Plateau equilibrium Step inflation lung OD.CPAP Inspiration (I) - I / E ratio : conventional rate expressed in seconds. - i / e ratio : high frequency rate expressed in milliseconds. Expiration (E) Time (sec) HFPV VDR4 : Pediatric SET-UP IT = 1.1 to 1.6 sec ET = 0.8 to 0.9sec ( I/E ≈ 1/1 for Low Frequency = 32 a 38 cycles/min) HF = 500 to 700 cycles/min i/e = 1 / 1 to 1/1.5 PIP = 25 to 35 cm H2O i Oscillatory CPAP = 6 – 8-10 cm H2O e PIP FiO2 : 1 (and according to BGA) Demande CPAP/PEEP = O ! I E CO2 Washout • i/e (1/2.5 - 1/3.5) • HF ( ≈ 400 - 450 cycles/min) • ET to Low frequency • Progressive PIP by level of 2 cmH2O • Convective Pressure rise. Oxygenation • i/e (1/1) • HF ( 750 - 800 cycles/min) • IT , ET will be adjusted for I/E =1.6/1 • FIO2 • Osc. CPAP • Convective Pressure rise. • Progressive PIP by level of 2 cmH2O VDR4 VDR SET UP PIP/PEEP/FIO2 To keep: Ph ≥ 7.30, SpO2 ≈ 92-95%, PaCO2 ≈ 35-45 mm Hg FIO2: SPO2 ≈ 95 to 100 % I Time: 1.4 seconds E Time: 0.8 seconds Low rate: ≈ 34 Pulse Frequency: ≈ 500 (with i/e: 1/2) Pulsatile Flowrate: 30 - 40 cm H2O Obtain: Chest XRay, ABG, Within 2 hours of VDR set Up If: SPO2 < 90 or PaO2 < 60 mmHg If: Oscillatory cpap: 6 cm H2O Yes PaCO2 Yes PaCO2 Yes > 45 mmHg If: < 30 mmHg 1. Pulsatile Flowrate 2 cm H2O increment. 2. Add Convective Pressure Rise. 3. Oscillatory Cpap. 4. ,, Inspiratory Time 0.1 second increment. 5. ,, FIO2. 1. Pulsatile Flowrate 2 cm H2O increment. 2. Inspiratory Time 0.1 second increment. 3. Reduce Pulse Frequency ( i/e: 1/2 to 1/3). 4. ,, ,, ,, Oscillatory Cpap. 5. Add Convective Pressure Rise. 6. Assess for airway obstruction. 1. Pulsatile Flowrate 2 cm H2O increment. 2. Expiratory Time. 3. Pulse Frequency ( i/e: 1/1). 4. Oscillatory Cpap if SPO2 ≥ 95 %. If SPO2 ≥ 95 % then: Reduce FIO2 10 % increment. Reduce Pulsatile Flowrate 2 cm H2O increment. Reduce Oscillatory Cpap by 1cm H2O increment. Don’t reduce Osc.Cpap < 4 cm H2O. Concider Extubation when: FIO2 ≤ 30 %. Pulsatile Flowrate < 20 cm H2O. Low rate ≤ 15 cycles /min. With I time ≈ 1.2 second. Chest X-Ray with minimal infiltrates. Eventually Transition To N.I.V. To reduce W.O.B.