Cheatography
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Guide to HFOV setting and titration
This is a draft cheat sheet. It is a work in progress and is not finished yet.
Mean Airway Pressure
Select MAP 2-3 above CMV (or 11-12 if directly starting on HFOV). |
Increase MAP by 0.5 every 2 minutes while aggressively weaning fio2 for goal saturations. |
Once goal fiO2 reached (ideally 30%), decrease MAP by 0.5 every two minutes until MAP begins to rise, then set MAP to be 1 above the current level. |
Note 1: If MAP is 8-10 above starting MAP, obtain CXR to check expansion (ideally ~9-10 ribs) |
Note 2: Use caution with this strategy with air leak syndromes |
Note 3: Cycle Blood Pressure every 2 minutes and note HR and perfusion while employing this strategy |
Frequency
RDS (↓Compliance)
<30 weeks: 15Hz
>30 weeks: 12-15Hz |
Meconium Aspiration Syndrome
Early (↑Resistance): 6-8Hz
Late (↓Compliance): 12-15Hz |
Chronic Lung Disease (↑Resistance, ↓Compliance)
12-15Hz |
Pneumothorax/Severe PIE
6Hz (maximize expiratory time) |
Atelectasis/PNA
12-15Hz |
CDH
10-15Hz (start higher) |
Depends on underlying pathophysiology. Think about Time Constants. |
Time Constant = Resistance x Compliance. Shorter Time Constants equal higher Hz. |
i-Time
Set to 33% under the vast majority of conditions |
Set at 30% for air-leak syndromes (pneumothorax, PIE, etc) |
Increase to 50% as a last resort (first optimize Power, Hz, ETT size, exhaust other modes of ventilation)
Caution: high risk of air-trapping, which may happen very quickly |
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Titration
Oxygenation
MAP, FiO2 |
Ventilation
Power (AMP), Hz, i-time |
Note: may need to increase MAP to open up collapsed lungs prior to adequate ventilation |
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