PART II of High Frequency Oscillatory Ventilation - Tala Talks NICU

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Hz? MAP? Amplitude? Learn all about the settings used and the clinical applications of neonatal HFOV. Learn in which clinical scenarios we use HFOV. Has it been proven to be helpful. Which settings do we start neonates on? How do we wean or escalate care? Tala Talks NICU
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Please be sure to give us a like, comment about future topics, and subscribe to this channel to stay up to date on all things NICU! Also, click the notification bell after you subscribe to gain your weekly NICU knowledge as soon as it's loaded!
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Dr. Tala is a board-certified neonatologist, and has worked in busy level III and IV units for the past 15 years. She has won multiple teaching awards throughout her time as a neonatologist.
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References:
Elective High Frequency oscillatory ventilation vs. conventional ventilation for acute pulmonary dysfunction in preterm infanta. 2015 The Cochrane Collaboration. Cools et al.
Use of high frequency oscillatory ventilator in neonates with respiratory failure: the clinical practice in Taiwan and early multimodal outcome prediction. Mei-Chin Yang et al. Scientific Reports 2020
An observational, prospective, multi center study on rescue high-frequency oscillatory ventilation in neonates failing with conventional ventilation. Erdeve et. al. PLOS ONE 2019
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**TIMESTAMPS**
2:03 Clinical uses of HFOV
11:56 Settings used for neonatal HFOV
12:18 I Time
12:44 Flow
13:15 Frequency (Hertz)
18:06 MAP
20:51 Amplitude (Delta P)
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Music: www.bensound.com (royalty free with credit)
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*Disclaimer*: This video is intended for educational purposes only and while
we strive to give the most accurate information, errors may occur. Subsequently,
this video should not be a replacement for medical advice.

Опубликовано:

20 июл 2024

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Комментарии : 107

@nicurn5030 2 года назад

WOW..BEAUTIFULLY AND THOROUGHLY EXPLAINED. THANK YOU.

@TalaTalksNICU 2 года назад

Thank you so much! You’re so encouraging! We bet you’re great to work with :)

@wparsa 2 года назад

Your videos and the way you teach are wonderful. Tala in Persian means, GOLD, precious, invaluable. Actually, your channel is GOLD and precious.

@TalaTalksNICU 2 года назад

Oh I LOVE that! In Arabic it means a 'little palm tree' so I think I prefer the Persian translation! ha! (Although a viewer from the Philippines told us it also means 'star'! ha!) Honestly though- this has been a massive team effort- we all collaborate on the videos, and Arianna spends HOURS making them more understandable!! Ha! Thanks so much for being here :)

@britneywebster2669 2 года назад

I’m in NNP school and all of these videos have been SO helpful! Thank you so much for making them. I would love a video about the jet as well as more practice blood gas videos.

@TalaTalksNICU 2 года назад

That's fantastic Britney-thanks for letting us know :) We are definitely planning another lecture on the jet (relatively soon)-and more gas lectures too. Good luck on your studies!!

@foulgerfam9370 2 года назад

I am a new NICU nurse and your channel is the most helpful thing I've found in my training! THANK YOU SO MUCH for all your time, effort, knowledge and wisdom!

@TalaTalksNICU 2 года назад

Congratulations on finding the best field Fougler! We are SO happy these are helpful. Thank you so much for subscribing and for taking the time to comment :)

@hossamyasser8651 Год назад

I love your explanations. Thank you for your presence on RU-vid.

@TalaTalksNICU Год назад

Thank you so much for your presence on this channel! We love all your motivating comments :)

@lexismorley8226 Год назад

This is very helpful. I would love to see video helping to understand Jet ventilation! I am doing a PA NICU residency and currently caring for my first jet patient 😵‍💫

@TalaTalksNICU Год назад

Oh congratulations on your residency! We have jets down on our list- we promise we'll get around to it when we finish our cardiac series :) Thank you so much for being here!

@vinetrarodrigues1727 2 года назад

Amazing video. Beautifully explained. Cleared concepts pretty well. Thanks a ton for this series

@TalaTalksNICU 2 года назад

SO happy you found it clear. These are my favorite videos we've filmed (Tala) so I'm extra appreciative here!!!

@naitramsingh6942 2 года назад

Amazing work from you and your team, really helpful and concise, thanks for getting this done

@TalaTalksNICU 2 года назад

Wow! Thanks Naitram. We really appreciate you taking the time to comment :)

@monjidibrahim1168 2 года назад

You have amazing way of teaching Big thanks for your great efforts.

@TalaTalksNICU 2 года назад

Thank you so much Monjid! You have a lovely way of commenting :)

@katarinahrossova715 2 года назад

Hi Tala ! :) … thank you and your team for an extra work you’re doing to educate us … this channel is excellent ! … I wanna ask if you are planning to do a lecture on specific ventilator modes, NEC, Covid-19 infection in newborn, sepsis, pneumotorax or maybe some critical congenital anomalies (CHD, diaphragmatic hernia, GIT atresia etc.) … thank you again ( Katarina, Slovakia )

@TalaTalksNICU 2 года назад

Hi Katarina! Thanks so much for your lovely words and suggestions :) Those are all excellent subjects. We are starting with NEC this week- but we will plan on all the others too. Thanks for being here!

@mohamedekhouli7966 2 года назад

Really helpful, simplified and to the point.

@TalaTalksNICU 2 года назад

Thank you so much- we're so glad you found this helpful. Thanks for watching and for taking the time to let us know!

@carolyngoodson8388 2 года назад

I am in NNP school and finding all of your videos to be awesome. This one is especially helpful. Super grateful for your explanations and will continue to watch. Going to see if you have one on TPN, chest tubes, electrolytes, RAAS system... looking forward to watching all your videos!

@TalaTalksNICU 2 года назад

Oh Carolyn that makes us so happy! Thanks! We haven't done TPN and electrolytes yet (SO massive- but we have to get around to it!). Chest tubes we're tying to work out how would be helpful without a baby (we need a sim toy I think!). And what does RAAS stand for? sorry not sure what that acronym is! Thanks for being here- we're so glad we're of some help :)

@user-os7rz6iw4n 2 года назад

Oooo me too! I am in nnp school!These videos are awesome

@mrhaoleinhawaii 2 года назад

@@TalaTalksNICU renin-angiotensin-aldosterone system (RAAS)

@TalaTalksNICU 2 года назад

Yes of course!!!! That is a GREAT idea too- thank you!

@shijajacob3983 2 года назад

Hi Dr Tala,I’m a NICU Nurse from Saudi Arabia.I like ur videos very much.Love ur ability to concise the topics and explain in simple as maximum.Really enjoying ur teaching and grasping a lot. Keep on 💐😍

@TalaTalksNICU 2 года назад

Thank you so much Shija, for taking the time to send us this lovely comment. Messages like yours definitely make us want to keep going :)

@ciniravichand1204 2 года назад

Excellent practical learning, Thank you Dr.Tala

@TalaTalksNICU 2 года назад

Thanks so much Cini, that is definitely our aim- practical information for the bedside. Thanks for watching and for letting us know!

@chakalucious5115 5 месяцев назад

You are awesome! You explain this so well, I understand and I am more comfortable now! 😊

@TalaTalksNICU 5 месяцев назад

Oh so happy that it helped at all! Thanks for letting us know :)

@gelilawitasefa6247 2 года назад

This is an excellent explanation. As a neonatal-perinatal fellow, I have never heard anyone teach/explain this rather complex topic in a way that is so understandable. Thank you very much for that. I wish you taught some topics on Med Ed ON THE GO. Will you have some talks on the different modes of conventional ventilation like volume mode and also assist control? what about HFJV? That would be awesome. Thank you

@TalaTalksNICU 2 года назад

Thank you so much Dr. Asefa. I can't tell you how happy that makes us. It is a super-complex topic, and I'm sure there are hard core mathematicians out there who would be disappointed I didn't go deeper into the different mechanisms of gas exchange and the physics behind it all! I've never heard of Med Ed on the Go- is it a similar format? It's so great there are all these amazing resources now for learning. We are planning a video on the jet soon (the same type of video as the oscillator ones). But for the different modes on the conventional ventilators, I'd love to be able to do that bedside, on an actual vent. It would be much easier for everyone to understand, I think, if they saw it live. We're figuring out how to do that without breaking any hospital rules etc!. (In the meantime- the vent lecture part 2- gives some basics on conventional vents. This is probably already pretty basic for you though). Thanks again for writing to us and for watching!!

@sanjaychoudhary6381 2 года назад

Wonderful lecture.perfect science and practical tips.

@TalaTalksNICU 2 года назад

So glad you think so Sanjay. Thanks so much for watching and commenting :)

@chrissurike Год назад

A lot of good information. I would like to add that the amplitude is NOT a setting. The amplitude is a measurement only. The Power is the setting. The power controls the piston. The amplitude fluctuates in response to compliance and resistance of the circuit, airway, and/or the patient lung. Ordering a set amplitude can be a dangerous practice.

@TalaTalksNICU Год назад

Thanks Chris for your comment! You're absolutely right the power is what determines the delta P and the actual setting that needs to be adjusted- but I'm guessing you come from the RT side of things- as in every NICU I've worked in, the order we place is always for delta P or amplitude. Thankfully, the NICU RTs are always are of this. And I agree- any ventilator in the wrong hands- just like any machine- is dangerous. Thanks!

@henrypaknotes 2 года назад

Thx again for ur video. It would be excellent if u can cover the topic on NIV NAVA next video. Again, thx for all ur team’s effort and sharing! Gd day.😉

@TalaTalksNICU 2 года назад

We love all your comments Henry Pak! Thank you so much! We promise we are getting around to non-invasive forms of ventilation soon! Thank you for continuing to watch these :)

@anitangqunge9531 2 года назад

Thanks for the good explanation Dr Tala

@TalaTalksNICU 2 года назад

We're so glad you found it helpful Anita. Thanks so much for taking the time to comment!

@jamieblack8197 2 года назад

Do you all have plans to do videos to help NICU RNs study for their NICU certification? Thanks! You guys are amazing!

@TalaTalksNICU 2 года назад

Hello Jamie! we hadn't discussed this- but it's an excellent idea. I'm not sure what the NICU nursing certification involves? What resources do nurses usually use? Once we look over them we could tailor our videos more specifically to make sure we cover relevant topics. Any info would be so valuable! Thanks!!

@PPN1942 2 года назад

Can you talk about chest tubes, if you hadn't already? Thank you to you and your team for all your hard work.

@TalaTalksNICU 2 года назад

Yes PN! This is a great idea- the problem is figuring out what would be the most helpful thing to do, given we can't show anything on a patient. We will try to find an adequate set up for a simulation. Thanks!!!

@kyleFed 2 года назад

great hfov series!

@TalaTalksNICU 2 года назад

So glad you liked these- we loved choosing what information to include! Thank you!!!!

@ELITEBloody642 2 года назад

Dr. Tala, thank you for your wonderful videos. I have questions which you partly eluded to in your videos: a.) What would be max vent settings on AC-PC and VC-AC at which point you would consider changing over the HFO? b.) What would be max values in terms of MAP and Amplitude? c.) What would be suitable extubation parameters for conventional and HFO? d.) In term of CMV in neonates we mostly use volume control. When would I change over the pressure control> e.) Why when changing form Draeger VN500 to Sensormedic can I sometimes see such significant changes in my next PCo2 even though I am using the same settings? Sorry I know it is a lot. Thank you so much for your help.

@TalaTalksNICU 2 года назад

HI Bettina! These are excellent questions- and they're all super dependent on the patient and the unit0 (AND THE XRAYS- if you're super-inflated- doesn't matter how low your pressures are- you don't want to go higher)- but it's always nice to know how different units do stuff- so we'll make some suggestions! a) Max AC-PC- rate 40, pressures needed in 30s (or high 20s for preemies). Volume control- not getting there with Tv > 6ml/kg or needing super high pressures to get you tidal volumes b) Max values oscillator- really dependent on the Xrays- but have gone up to a mean of 30 and delta P of 50 in term sick kids (lower in preemies) c) Extubatable- you want to get as low as possible- especially with the mean- low teens for the oscillator, preferably. d) Generally you would change to pressure control if you had a large leak with the ETT (unable to accurately measure pressures)- or for whatever reason you're using much higher pressures than you'd feel comfortable with achieving the volumes. e) ALL the machines are completely different! And for whatever reason- some babies just hate a form of gas exchange over another. We'e definitely had those situations where we've tried the jet or the oscillator and a baby has hated both and we've gone back to a regular ventilator. Ultimately you want to be on the machine that can oxygenate and ventilation for the baby with the least support possible!!! Hope these vague answers help!!

@cricketgirl4 Год назад

Hi Dr. Tala and team! Thank you so so much for putting this together. This lecture was very helpful and you explained it beautifully!! I wanted to get your thoughts on sedation and using paralytics while on HFOV? Most neos will sedate otherwise the premies are constantly fighting and their MAP is drifting and some of our neos are completely against sedation and/or paralytics. I am a NICU educator and i have a symposium coming up and HFOV is one of our hot topics. I wanted to get your thoughts on this. Thank you so much in advance 😊

@TalaTalksNICU Год назад

Hello! Great question!!! I’m just going to speak for myself here (Tala)- Arianna and Justin may think differently. Generally- I try to avoid every single medicine that I don’t think is definitely needed. Once we start sedatives/ pain meds on high frequency- we’re probably not going to stop them any time soon-so if it’s a 22-23 weeker then that could be a few weeks on the meds. Especially- since every few years- we worry about the effect of a specific med on development. Also apparently, adults on the oscillator- specifically- have likened it to getting a massage. I don’t know if this is true! But some babies can look very comfortable on the machines. Having said all of this- if the bedside nurse tells me once the baby looks uncomfortable- I’ll write for anything! Not sure if that’s helpful?!!!

@TalaTalksNICU Год назад

And definitely not paralytics - unless that’s literally only way to keep baby alive. Paralytics end up with the baby retaining water and collapsing areas of the lungs- so may be helpful short term but then you’re in a worse state. Sometimes - sedation does help the machine do its job- so here again- would use it (eg bad pulm HTN baby who we definitely don’t want agitated)

@ziahassan6640 2 года назад

Thanks Tala

@TalaTalksNICU 2 года назад

Thank YOU- for watching!

@nyinggypo3373 6 месяцев назад

Beautifully explained Mam

@TalaTalksNICU 6 месяцев назад

Thank you so much- appreciate you being here and taking the time to comment- thank you

@nafisayasir6183 Месяц назад

Very nice explanation❤

@TalaTalksNICU Месяц назад

Thank you so much- glad you think so

@fairooslebbe3000 2 года назад

Dr Tala thank you very much for teaching me through this channel 600gm 23 Wk on hfov due to unable to ventilate with SIPPV with pip of 22. Day5 today still unable wean to conventional ventilator. Other pphn, air leak, .. causes excluded. Why?

@TalaTalksNICU 2 года назад

Dear Fairoos- at 23 weeks the lungs are so exceedingly immature that it doesn’t take a “cause” to need high settings and high oxygen. You have to wait it out while you concentrate on growth and be as gentle as possible. Sorry took time to get back!

@JamesonMJr 2 года назад

Do you use the Niv-Nava? If so can you please do a video on it.

@TalaTalksNICU 2 года назад

Hello Jameson! We have all used NIPPV (non invasive positive pressure ventilation) a lot, and we have used NAVA in the past bot not frequently. Both are excellent suggestions for videos. Thanks so much!

@ziahassan6640 2 года назад

Really informative

@TalaTalksNICU 2 года назад

Thanks so much Zia!

@marinajohn4022 2 года назад

Could you please consider doing ostopenia of prematurity especially physiology, diagnosis and treatment 🙏

@TalaTalksNICU 2 года назад

Yes! That's a great topic... although with the excellent improvement in nutrition in the last decade or so, we see bad osteopenia so much less. Thanks for a great suggestion!

@griffinanasi6646 2 года назад

Thanks Dr Tala Kindly as well consider nitric oxide therapy on neonates

@TalaTalksNICU 2 года назад

Hello Griffin- thanks so much for watching this too. We touched on iNO in the PPHN video, but we can also discuss it more broadly as a medication. When else do e use it? In preemies? What dose? How do we wean? We can definitely get to that- thank you!!!!

@najmiusman7028 Год назад

U are best

@TalaTalksNICU Год назад

Ha! Def not but appreciate the sentiment!!

@kathleencarney Год назад

could you do a video on the jet?! thanks!

@TalaTalksNICU Год назад

Yes- we are definitely planning on this in the New Year. Thank you for watching and for taking the time to comment :)

@faride2486 Год назад

thanks

@TalaTalksNICU Год назад

Thanks for watching!

@Saraviacastro2 29 дней назад

question! Do you completely sedate and relax de baby? is it 100% neccessary ?

@TalaTalksNICU 28 дней назад

Great question- we try to NEVER sedate a baby unless we really really have to. So unless baby is fighting the vent and not doing well we try not to. If baby looks comfortable we won’t give anything. (Like hopefully feels like a massage). Obviously we don’t want any baby fighting the vent and grimacing etc- so we’ll give meds if we have to!

@user-wj8ec7mf1c 2 года назад

Amazing

@TalaTalksNICU 2 года назад

Thanks so much for your continued support.

@michaellaviola3125 2 года назад

Can you do videos on neonatal resuscitation

@TalaTalksNICU 2 года назад

Hello Michael! We have been going back and forth with representatives from the AAP (who are responsible for NRP)- and hopefully they are about to allow us to film a video on NRP and 8th edition updates. Stay tuned!!

@PROFKASPER 7 месяцев назад

Hello Dr. Tala Why in HFO we going up MAP by 2 - 4 cm H2O more than that of conventional ventilator? Thanks in advance

@TalaTalksNICU 7 месяцев назад

Generally we’re going on an oscillator because we need more help with oxygenation- so this helps that. But we consider it less damaging to provide this constant open pressure this way and so we can afford to give a higher MAP. I haven’t seen a study that compared the expansion at different means on different machines (and briefly tried looking)!!

@PROFKASPER 7 месяцев назад

@@TalaTalksNICU Thanks 🌹

@PROFKASPER 7 месяцев назад

I searched for that I found There is an open lung strategy of *- High volume lung strategy in which we add 2-4 to MAP and used in most conditions when the HFOV is the ventilatory support **- Low volume lung strategy in which we substract 2 from the MAP value It is recommended in patients with air leak syndromes

@ikamos5919 Год назад

Amazing videos , all the information is entering braincells in a high ΔP but with a low MAP !!!😄

@TalaTalksNICU Год назад

HA! That's perfect!! Thanks!!!

@user-ux2pl9ek6f 7 месяцев назад

have you made a jet video?

@TalaTalksNICU 7 месяцев назад

NO! SORRY!!! Will be first one out in new year (when we’re releasing next NICU videos)

@Imrann752 9 месяцев назад

Can you a video on JET

@TalaTalksNICU 9 месяцев назад

YES! Will happen before end of year- I promise!!!!

@user-wj8ec7mf1c 2 года назад

Wiggle normal reach umbilicus or not

@TalaTalksNICU 2 года назад

YES! Thanks for mentioning this- we WANT the wiggle to extend to the umbilicus in babies. Thank you!

@nevillrl2110 2 года назад

What about sedation? Paralyzed?

@TalaTalksNICU 2 года назад

Great question- we've really reached the point in neonatology that the LESS we can do to babies- especially with medications etc- the better it will be for them. We don't know the full developmental effects of routinely giving narcotics or benzos etc. So- we wouldn't routinely sedate a baby unless it meant that it was really affecting oxygenation and ventilation. (Adults have said that being on an oscillator can feel like a massage). We try to never paralyze babies (unless for operations)- unless it's an absolute point of desperation. Generally, once they're paralyzed, they become more edematous, which worsens their respiratory status even further. So if you're trying to keep a. baby alive or off ECMO, then we can do this- otherwise, we really try to avoid it. Excellent questions- thank you!

@najmiusman7028 Год назад

Some thing on fluid management

@TalaTalksNICU Год назад

Hello! If you go to our home page we have a playlist on fluids and electrolytes- maybe start there. If there’s something else you’d like us to discuss we can cover it! Thanks for being here :)