• David W Kaczka, Jacob Herrmann, C Elroy Zonneveld, David G Tingay, Anna Lavizzari, Peter B Noble, and J Jane Pillow.
• From the Departments of Anesthesia, Biomedical Engineering, and Radiology (D.W.K.) and Department of Biomedical Engineering (J.H.), University of Iowa, Iowa City, Iowa; Neonatal Research, Murdoch Childrens Research Group, Melbourne, Victoria, Australia (C.E.Z.); Department of Paediatrics, University of Melbourne, and Neonatal Research, Murdoch Childrens Research Institute, and Department of Neonatology, Royal Children's Hospital, Melbourne, Victoria, Australia (D.G.T.); Neonatal Research, Murdoch Childrens Research Institute, Melbourne, Victoria, Australia, and NICU, Fondazione IRCCS Ca'Granda, Ospedale Maggiore Policlinico Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy (A.L.); School of Anatomy, Physiology, and Human Biology, and Centre for Neonatal Research and Education, School of Paediatrics and Child Health, University of Western Australia, Perth, Western Australia, Australia (P.B.N.); and School of Anatomy, Physiology, and Human Biology and Centre for Neonatal Research and Education, School of Paediatrics and Child Health, University of Western Australia, and Neonatal Clinical Care Unit, Women and Newborn Health Service, Perth, Western Australia, Australia (J.J.P.).
• Anesthesiology. 2015 Dec 1; 123 (6): 1394-403.

BackgroundDespite the theoretical benefits of high-frequency oscillatory ventilation (HFOV) in preterm infants, systematic reviews of randomized clinical trials do not confirm improved outcomes. The authors hypothesized that oscillating a premature lung with multiple frequencies simultaneously would improve gas exchange compared with traditional single-frequency oscillatory ventilation (SFOV). The goal of this study was to develop a novel method for HFOV, termed "multifrequency oscillatory ventilation" (MFOV), which relies on a broadband flow waveform more suitable for the heterogeneous mechanics of the immature lung.MethodsThirteen intubated preterm lambs were randomly assigned to either SFOV or MFOV for 1 h, followed by crossover to the alternative regimen for 1 h. The SFOV waveform consisted of a pure sinusoidal flow at 5 Hz, whereas the customized MFOV waveform consisted of a 5-Hz fundamental with additional energy at 10 and 15 Hz. Per standardized protocol, mean pressure at airway opening ((Equation is included in full-text article.)) and inspired oxygen fraction were adjusted as needed, and root mean square of the delivered oscillatory volume waveform (Vrms) was adjusted at 15-min intervals. A ventilatory cost function for SFOV and MFOV was defined as (Equation is included in full-text article.), where Wt denotes body weight.ResultsAveraged over all time points, MFOV resulted in significantly lower VC (246.9 ± 6.0 vs. 363.5 ± 15.9 ml mmHg kg) and (Equation is included in full-text article.)(12.8 ± 0.3 vs. 14.1 ± 0.5 cm H2O) compared with SFOV, suggesting more efficient gas exchange and enhanced lung recruitment at lower mean airway pressures.ConclusionOscillation with simultaneous multiple frequencies may be a more efficient ventilator modality in premature lungs compared with traditional single-frequency HFOV.

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