Initial Clinical Guidelines for HFOV
3100B in Adults
These guidlines are recommendations only and are based on data collected from clinical
trails with the Model 3100B. As for any treatment, each physician must determine the
appropriateness of these guidlines as they apply to specific patients.
1. Set initial mPaw at 5 cmH2O pressure above the conventional
You may consider a recruitment maneuver first if patient is
extremely hypoxic by applying 40 cmH2O for 40-60 sec.
If oxygenation worsens, increase mPaw in 3 - 5 cmH2O
increments Q 30 min until maximum setting. (Note: oxygenation
typically may worsen in the first 30 minutes of recruitment in
Check a chest-x-ray within 1 - 4 hrs of initiating HFOV to
assess lung volume.
2. Set power at 4.0 and rapidly increase to achieve chest wiggle. (visual
vibration from shoulders to mid-thigh area).
Transcutaneous monitoring for TcCO2 should be done.
If PaCO2 worsens (but pH > 7.2), increase the power setting to
achieve a change of amplitude in 10 cmH2O pressure increments
Q 30 minutes up to a maximum setting.
If pH is < than 7.2, consider buffering pH.
An abrupt rise in PaCO2 in an otherwise stable patient should be
considered an obstruction of the endotracheal tube, until proven
Set Hz at a range of 5 - 6 initially.
May decrease the Hz if unable to control the PaCO2 with amplitude.
Decrease the Hz by 1 at a time Q 30 min until you reach a level of 3
Set IT at 33%.
May increase up to 50% IT if unable to ventilate by increasing
amplitude or by first decreasing frequency.
If severe hypercapnea with pH > 7.2, consider decreasing the
endotracheal tube cuff inflation to produce a leak.
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.
Rule out obstruction in endotracheal tube with bronchoscopy.
Initial FiO2 at transition to HFOV should be set at 100%.
As oxygenation improves, gradually wean FiO2 to 40%, then slowly
reduce mPaw 2 - 3 cmH2O Q 4 - 6 hrs until mPaw is in a 22 - 24
When the above goal is met (but no sooner than 24 hours), switch to
PCV. Initial settings:
PIP titrated to achieve delivered TV of 6 - 8
Pplat < 35 cmH2O.
I:E of 1:1.
PEEP - 12 cmH2O.
Rate 20 - 25 / min.
mPaw should be 20 cmH2O (± 2 cmH2O)
Viasys Healthcare Critical Care Division
22705 Savi Ranch Parkway
Yorba Linda, CA 92887
P/N 773969B - L2047 03/02
Viasys Healthcare Critical Care Division BV
3723 BG Bilthoven
Telephone: (31) 30 2289711
(31) 30 2286244