HFOV

Index
• What is HFOV
• Mechanisms Used in HFV
• Mechanism of Gas Exchange
• Indications of HFOV
• Types of HFV available
• Comparison Between Various HFV
• Advantages of Dragonfly
• Clinical data
• HFOV at a Glance
• Way Ahead

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 What is HFOV
• HFOV is best described as CPAP with Wiggle.
• It’s a New form of Ventilation used mostly when Conventional
Ventilation Fails. (old school of thoughts)
• Diseases Like RDS , ARDS , MAS , Pneumonia , Air Leaks ,
Lung Hypoplasia and PPHN are treated more successfully on
a HFOV than on a Conventional Ventilator.
• HFOV is a Most Popular device among all other HFV.
• HFOV is a device that is capable of delivering very small tidal
volumes at very High Rates.
• The Delivered Tidal Volume is less than or Equal to
Anatomical dead space volume.
• High Respiratory Rates ensures maintaining the minute
volume.

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 Mechanisms Used In a HFV

• Loud Speaker Technology ( Diaphragm)

• Mechanical/ Electro Magnetic Piston
• Flow Chopping Mechanism (Rotary Motion Valves)
• Jet pulses
• Solenoid Valves

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Mechanisms of Gas Transport
Five Different Mechanisms Explains the Gas Exchange In a HFOV
A) Transit time Profile ( conventional Bulk flow )
B) Pendeluft Effect ( Interregional Gas Mixing)
C) Taylors Dispersion ( Augmented Dispersion)
D) Asymmetric Velocity Profile
E) Molecular Diffusion

Clinicians Understand these well !!!

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 HFOV Principle
CDP
Adjust
Valve

ET Tube Oscillator

Patient
BIAS Flow

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 Indications Of HFOV
All are Relative Indications Especially when there is:
• Oxygenation Failure.
• High PaCo2
• Etiology of Parenchymal Lung Disease.
• Inadequate Oxygenation that may lead to VALI.
• When Conventional Ventilator is Failing Especially in
– MAS ,
– Pneumonia ,
– PPHN,
– Pulmonary Hemorrhage
– Severe ARDS
• Objectively Defined by
– PIP > 30 – 35 cmh2o
– Fio2 > 0.6 OR Inability to Wean
– MAP > 15 Cmh20
– PEEP > 10 Cmh2o
– Oxygen Index >15

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 Types of HFV Available
Four Types of High Frequency Ventilators are Available in the
Market

1. HFPPV – High Frequency Positive Pressure Ventilator

2. HFFI – High Frequency Flow Interrupter
3. HFJV – High Frequency Jet Ventilator
4. HFOV – High Frequency Oscillatory Ventilator.

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 Comparisons Between Various
HFV Available
• High Frequency Positive Pressure Ventilation ( HYBRID VERSION) : A
Conventional Ventilator Using High R.R. Ranging from 60 to 150 BPM ( 1 to 2.5 Hz).
However Expiration Phase is Passive, Hence Chances of Bara trauma are Very
Severe.
• High Frequency Flow Interrupter (HYBRID VERSION): Conventional Ventilator
Using Flow Chopping Mechanism
– Expiratory Gases are Chopped at a very High Rate which Creates Vibrations and are
Reverberated back to the lung
– A Venturi System in the Expiratory limb ensures Maintenance of set MAP
– Expiratory Phase is Passive.

• High Frequency Jet Ventilation : Used in Conjunction with Conventional Ventilator.

– Requires a Special Triple Lumen Tube.
– Short Jet Pulses are Delivered Intermittently
– Expiratory Phase Is Passive

• High Frequency Oscillatory Ventilator :

– The Most Popular Device Among All HFVs’
– Active Inspiration and Active Expiration is Possible
– Oxygenation and Ventilation can be adjusted Separately
– MAP can be set Individually which is not possible on C.V.

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 Settings and Controls on
HFOV
• BIAS Flow
– Auto Adjusted in DRAGONFLY Servo Controlled.
– Manual Adjustment on Sensormedics 3100 A.
• Mean Airway Pressure ( MAP)
– Manual Adjustment in Sensormedics
– SERVO Controlled in DRAGONFLY.
• Piston Positioning
– Manually Adjusted In Sensormedics.
– Auto Adjusted in Dragonfly ( SERVO Controlled)
• Amplitude / POWER / DELTA p
• Frequency / Hertz
• Inspiration time OR I:E ratio

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 Settings on
Settings on
Sr. No Parameters Conventional
HFOV
Ventilator

1 Bias Flow Yes Yes

2 F/R.R /BPM/ Yes Yes

3 PEEP Yes No

4 PIP Yes No

5 Fio2 Yes Yes

6 Ins Pause Yes (If desired) NA

7 Exp Pause Yes (If desired) NA

8 Flow Pattern Yes (If desired) NA

9 Trigger Yes (If desired) NA

10 MAP NO Yes

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 Key Factors in HFOV
• Oxygenation :
Depends on:
– MAP and
– FIO2

• Ventilation
Depends on
– Amplitude
– Frequency
– Inspiration time

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•
HFOV at a Glance
Inspiration and Expiration both are Active on a HFOV
• HFOV Uses Very High Rates ( 300 to 1050 BPM i.e 5 to 18 Hz )
• Delivered Tv is less than or Equal to Anatomical Dead space Volume.
• Ideal Method of Ventilation to reduce VALI.
• Avoids Repetitive recruitment and derecruitment of Diseased Alveoli .
• Oxygenation and Ventilation both are Adjusted Individually on a HFOV which is not
possible on a C.V.
• Amplitude decides Tidal volume Delivery
• MAP can be set Individually on a HFOV
• MAP is Set to Open up the Lungs and Keep it open ( Same as in CPAP)
• Oscillations / Vibrations are created on the set MAP Hence known as CPAP with
Wiggle.
• Standard ET tube can be used.
• T.v x T.v x F Describes The Alveolar Ventilation.
• Inspiration time is set in percentage.
• IMPORTANTLY : During the course of Treatment the Inspiration
time and frequency is rarely changed as compared to C.V.
• Relatively Large BIAS Flow is required as compared to C.V
• Most Gentle Form Of Ventilation as compared to C.V.
• IN C.V. pressure changes from PEEP to PIP causes “Pressure Stress to the
Already diseased Lung “
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Will HFOV become the Primary
Mode of Ventilation???

There are Two school of thoughts.

• One school of thoughts advocates
HFOV use in Selective Diseases.
• Second school of thoughts
advocates Elective Use of HFOV.

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 Why Dragonfly
• True SERVO Controlled Oscillator.
• USER friendly.
• End User Calibration - NOT Required.
• Compact Design.
• Next Gen Technology.
• Feather Touch Controls.
• 15 Inch TFT Display – Giving Graphical presentation of Flow V/s
Time , Pressure V/s Time Classical curves ,
– PMAX, PMIN, D.P, DCO2 , T.v , Inbuilt Training Module.
• Operates on Very Low Pressures Making it very safe (Working
pressure 100Cm H2O =1.5psig )
• I:E Ratio 1:1 and 1:2
• Active Inspiratory and Active Expiratory Phase.

• And Many More ………

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 Way Ahead
• In diseases like ARDS, MAS, PPHN, Increasing number of institutes are
advocating Elective use.
• The baby suffering from above diseases are directly placed on a HFOV.
• They do not wait for the conventional ventilation to fail, instead use the
HFOV as primary ventilation mode.
• They advocate that, Being a very gentle form of Ventilation it reduces the
stress to the already diseased lungs.
• It opens up the lung & keeps it Open thus avoiding Repetitive opening &
closing of the diseased lungs.
• It reduces the stress to the Infant, Reduces the Hospital stay & is more
financially viable for the parents.
• The important consideration is:
“ When you know that HFOV is the best remedy in these diseases why
not use it as a Primary mode”.

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