• Roberta Centorrino, Valentina Dell'Orto, Charlotte Boussard, Agathe Debray, Rafik Ben-Ammar, and Daniele De Luca.
• Division of Pediatrics and Neonatal Critical Care, "A.Beclere" Medical Center, Paris Saclay University Hospitals, APHP, Paris, France.
• Respir Care. 2022 Jul 1; 67 (7): 850856850-856.

BackgroundHigh-frequency oscillatory ventilation (HFOV) is widely used in neonatal critical care, and several modern ventilators using different technologies are available to provide HFOV. These devices have different technical characteristics that might interact with patient lung mechanics to influence the effectiveness of ventilation. To verify this, we studied the oscillation transmission of 5 neonatal oscillators in a lung model mimicking the mechanical patterns commonly observed in neonatal practice.MethodsThis was a benchtop, in vitro, physiological, pragmatic study using a model mimicking airways and lung of a 1-kg preterm neonate and the following patterns: normal (compliance: 1.0 mL/cm H2O, resistance: 50 cm H2O/L/s), restrictive (compliance: 0.3 mL/cm H2O, resistance: 50 cm H2O/L/s), and mixed mechanics (compliance: 0.3 mL/cm H2O, resistance: 250 cm H2O/L/s). Several permutations of HFOV parameters (variable mean airway pressure or amplitude or frequency protocols) were tested. Oscillations were measured with a dedicated pressure transducer validated for use during HFOV, and oscillatory pressure ratio (OPR) was calculated to estimate the oscillation transmission.ResultsOverall OPR (calculated on all experiments) was significantly different between ventilators and the mechanical patterns (both P < .001). Different ventilators and patterns accounted for 35.6% and 20.6% of the variation in oscillation transmission, respectively. Sub-analyses per changing amplitude or frequency protocols and multivariate regressions showed that VN500 (standardized β coefficient [St.β]: 0.548, P < .001) and Fabian HFO (St.β: 0.421, P < .001; adjusted R2: 0.615) provided the best oscillation transmission. Fabian HFO also delivered oscillations with the lowest variability when increasing amplitude.ConclusionsIn an experimental setting mimicking typical neonatal lung disorders, the oscillation transmission was more dependent on the ventilator model than on the mechanical lung conditions at equal HFOV parameters. Fabian HFO and VN500 provided better oscillation transmission overall, and when increasing amplitude, Fabian HFO delivered oscillations with the lowest variability.Copyright © 2022 by Daedalus Enterprises.

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