3100B initial clinical guidelines
These guidelines are recommendations only and are
based on data collected from trials with the CareFusion
3100B HFOV, and assume the clinician has read and
understands the 3100B operator’s manual. The physician
must determine appropriateness of these guidelines as
they apply to specific patients.
1. Set initial mPaw approximately 5 cmH2O above the
conventional ventilator mPaw.
a. Consider a recruitment maneuver first if patient
is extremely hypoxemic.
b. If oxygenation worsens, increase mPaw in
3 to 5 cmH2O increments every 30 minutes.
c. Check a chest x-ray within 4 hours to assess
2. Set power at 4.0 and quickly adjust to achieve desired chest wiggle (visual
vibration from shoulders to mid-thigh area).
a. Transcutaneous monitoring for PCO2 should be considered.
b. If PaCO2 worsens (but pH > 7.2), increase the power setting to achieve a
change of amplitude in 10 cmH2O pressure increments every 30 minutes up
to a maximum setting. If increasing the amplitude, frequency or IT% does
not result in a significant decrease in PaCO2, strongly consider assessing lung
c. If pH is < 7.2, consider buffering pH.
d. An abrupt rise in PaCO2 in an otherwise stable patient should be considered
an obstruction of the endotracheal tube, until proven otherwise.
3. Set frequency in the range of 5 to 6 Hz initially.
a. Decrease the frequency if hypercapnea persists despite increases in amplitude
and confirmation of adequate lung volume.
b. Decrease the frequency by 1 Hz at a time every 30 minutes until you reach a
level of 3 Hz.
4. Set % inspiratory time (% IT) at 33%.
a. Consider increasing IT% up to 50% if hypercapnea persists despite increasing
amplitude, decreasing frequency and confirmation of adequate lung volume.
5. If hypercapnea persists, consider decreasing the endotracheal tube cuff inflation
to produce a leak.
a. Reduce the inflation of the cuff until you see a drop in the mPaw by
5 cmH2O. Readjust the bias flow to correct the mPaw level.
6. Initial FiO2 at transition to HFOV may be set at 100%. Alternatively, increase
current FiO2 by 10%.
Weaning from HFOV
1. As oxygenation improves, gradually wean FiO2 to 40%, then slowly reduce
mPaw 2 to 3 cmH2O every 4 to 6 hours until mPaw is in a 22 to 24 cmH2O range.
2. When the above goal is met (usually no sooner than 24 hours), consider
switching to pressure control ventilation (i.e., PRVC or APRV).
When returning a patient to conventional ventilation, mean airway pressure
values should remain similar to those employed in HFOV. Weaning from
conventional ventilation should follow individual institutional practice.
Typical initial settings (patient dependant):
a. PIP titrated to achieve delivered Vt of 6 to 8 mL/kg
b. Pplat < 35 cmH2O
c. I:E approximately 1:1
d. PEEP approximately 12 cmH2O
e. Rate approximately 20 to 25 per minute
f. mPaw approximately 20 cmH2O (+/- 2cmH2O)
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