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American Journal of Respiratory and Critical Care Medicine Vol 166. pp. 950-953, (2002)
© 2002 American Thoracic Society

Original Articles

Optimal High-Frequency Oscillatory Ventilation Settings by Nonlinear Lung Mechanics Analysis

Robert H. Habib, Kee H. Pyon and Sherry E. Courtney

Mercy Children's Hospital at St. Vincent Mercy Medical Center; Department of Pediatrics, Medical College of Ohio, Toledo, Ohio; and Department of Pediatrics, Cooper Hospital and Robert Wood Johnson Medical School, Camden, New Jersey

Correspondence and requests for reprints should be addressed to Robert H. Habib, Ph.D., Cardiopulmonary Research, St. Vincent Mercy Medical Center, 2213 Cherry Street, ACC Building, Suite 309, Toledo, OH 43608. E-mail: robert_habib{at}mhsnr.org

Use of nontidal high-frequency oscillatory ventilation (HFOV) while the lungs are expanded by an imposed airway pressure (Paw) in neonates is increasingly based on evidence of decreased risk of lung injury. However, an objective method to optimize Paw is lacking. We measured lung volume changes ({Delta}VL[t]) via respiratory inductance plethysmography over a range of Paw settings in five piglets before and after lung lavage. These multiple {Delta}VL(t) were then simultaneously fit by an exponential rise to maximum model, {Delta}VL(t, Paw) = {Delta}VL,max · (1 - e–(t/{tau})), where {Delta}VL,max was a sigmoidal function of Paw and {tau} varied with lung volume. Postlavage, the effective compliance (CEFF = {Delta}VL,max/Paw) was generally decreased, whereas {tau} increased, indicating a slower paced volume recruitment. Model-derived CEFF–{Delta}VL,max relationships were altered substantially after lavage and were sigmoidal with a bell-shaped derivative function. The maximum of its derivative corresponded to a favorable (or optimal) {Delta}VL/Paw where the maximal increase in compliance is achieved. In conclusion, CEFF–{Delta}VL,max data available from respiratory inductance plethysmography provided important insight to changes in lung mechanics. These also provided a basis of an objective method (1) to optimize Paw during HFOV and (2) to assess the efficacy of treatments and progression/regression of underlying disease in neonates managed with HFOV.

Key Words: respiratory inductance plethysmography • respiratory distress syndrome • preterm infants • lung volume • overdistention




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