High Frequency Ventilation

Dr. Rajiv and team have been successfully using high frequency ventilation since 1997. Dr. Rajiv was trained under Dr. Edward Bell from the university of IOWA, U.S.A. He has been recently trained in Jet Ventilation by Dr. Martin Kezzler George Town University, Washington in 2002. He has successfully used all ventilators with high frequency oscillation options including INFANT STAR HFO,BABY LOG 8000 HFO,SLE 2000 HFO plus,SENSOR MEDICS.He is currently a national instructor for high frequency oscillation(HFO) by virtue of his 'on hands' training program .He adopts the following strategies to optimize the lung volume.

• High frequency oscillation is a very good modality of ventilation in homogenous atelectatic lung disease (HMD ) and the Babylog 8000 has been extremely effective in the above disease states and shows more promise with its versatile modes like A/C and PSV with volume guarantee (VG) .
  HIgh frequency Jet Ventilation (Bunnel) may show more promise in unhomogenous lung disease (Meconium aspiration ) and the more powerful oscillators like Sensor Medics and SLE 2000 HFO plus could be equally promising in the above situation if used appropriately .
• High volume recruitment strategy : add a minimum of 2 to the MAP derived from conventional ventilation .
• When MAP > 13 and PIP>27 we convert to HFO.
• Hertz 10 Hz. for term baby on Sensor Medics, SLE and 12 Hz. in preterm on baby log, Under standard conditions.
  When more efficient gas exchange is required, especially if the lung is severly atelectatic 7 Hz. or rarely 5 Hz. could be considered.
• In severe pulmonary hypertension combination of HFO and nitric oxide is most successful . Moderate hypocarbia(CO2>=25) though not recommended is very effective in refractory cases.The experimental drug sildenafil along with HFO appears to be very promising. Nitric oxide delivery systems are different when HFO is used.The combination of the above have reduced the mortality from severe labile pulmonary hypertension to about 10 percent.
• In diaphragmatic hernia HFO plus nitric oxide is standard therapy and mortality has been significantly reduced.
• The routine use of HFO and the comfort levels with the same have prompted the team to use it as early rescue when FIO2 exceed 0.6 to 0.7 .This again has reduced the morbidity and mortality from refractory hypoxemia due to any cause significantly.