Comparison of the ventilation characteristics in two adult oscillators: a lung model study

Abstract

Abstract Background Two recent large randomized controlled trials did not show the superiority of high-frequency oscillatory ventilation (HFOV) in adults with ARDS. These two trials had differing results, and possible causes could be the different oscillators used and their different settings, including inspiratory time % (IT%). The aims of this study were to obtain basic data about the ventilation characteristics in two adult oscillators and to elucidate the effect of the oscillator and IT% on ventilation efficiency. Methods The Metran R100 or SensorMedics 3100B was connected to an original lung model internally equipped with a simulated bronchial tree. The actual stroke volume (aSV) was measured with a flow sensor placed at the Y-piece. Carbon dioxide (CO2) was continuously insufflated into the lung model ( V̇ $$ \dot{\mathrm{V}} $$CO2), and the partial pressure of CO2 (PCO2) in the lung model was monitored. Alveolar ventilation ( V̇ $$ \dot{\mathrm{V}} $$A; L/min) was estimated as V̇ $$ \dot{\mathrm{V}} $$CO2 divided by the stabilized value of PCO2. V̇ $$ \dot{\mathrm{V}} $$A was evaluated with several stroke volume settings in the R100 (IT = 50%) or several airway pressure amplitude settings in the 3100B (IT = 33%, 50%) at a frequency of 6 and 8 Hz, a mean airway pressure of 25 cmH2O, and a bias flow of 30 L/min. Assuming that V̇ $$ \dot{\mathrm{V}} $$A = frequency a × aSV b , values of a and b were determined. Ventilation efficiency was calculated as V̇ $$ \dot{\mathrm{V}} $$A divided by actual minute ventilation. Results The relationship between aSV and V̇ $$ \dot{\mathrm{V}} $$A or ventilation efficiency were different depending on the oscillator and IT%. The values of a and b were 0 < a < 1 and 1 < b < 2 and were different for three conditions at both frequencies. V̇ $$ \dot{\mathrm{V}} $$A and ventilation efficiency were highest with R100 (IT = 50%) and lowest with 3100B (IT = 33%) for high aSV ranges at both frequencies. Conclusions In this lung model study, ventilation characteristics were different depending on the oscillator and IT%. Ventilation efficiency was highest with R100 (IT = 50%) and lowest with 3100B (IT = 33%) for high aSV ranges.

Keywords

• High-frequency oscillatory ventilation (HFOV)
• Adult oscillator
• Inspiratory time % (IT%)
• Ventilation efficiency
• Actual stroke volume