Patient Management Guide
HFJV PIP
RAISE
LOWER
HFJV Rate
RAISE
LOWER
HFJV I-time
RAISE
LOWER
PEEP
RAISE
LOWER
CV Rate
RAISE
LOWER
CV PIP
RAISE
LOWER
CV I-time
RAISE
LOWER
General Guidelines
1. HFV ΔP (PIP - PEEP) is the primary determinant of PaCO2. HFV rate is secondary.
2. Resting lung volume (FRC supported by set PEEP) and mean airway pressure are crucial determinants of PO2.
3. Avoid hyperventilation and hypoxemia by using optimal PEEP. (See When to Raise PEEP below.)
4. Minimize IMV at all times, using very low rates (typically 0 – 3 bpm), unless IMV is being used to temporarily recruit collapsed alveoli. In general, keep IMV PIP 10 –
30% < HFV PIP.
5. To overcome atelectasis, IMV rates up to 5 bpm can be used for 10 – 30 minutes. Thereafter, IMV rate should be dropped back to 0 – 3 bpm. In general, keep IMV I-
time = 0.4 – 0.6 sec.
6. If lowering IMV rate worsens oxygenation, PEEP is probably too low. Higher PEEPs and lower IMV rates reduce the risk of lung injury.
7. Lower FIO2 before PEEP when weaning until FIO2 is less than 0.4.
RAISE
- To lower PCO2
LOWER
- To raise PCO2 (May raise PEEP simultaneously to keep MAP and PO2 constant)
HFJV Rate
RAISE
- To decrease PCO2 in smaller patients
LOWER
- To eliminate inadvertent PEEP or hyperinflation by lengthening exhalation time
- To increase PCO2 when weaning
HFJV I-time
RAISE
- To lower PCO2 when HFJV PIP is ineffective
- To enable Jet to reach PIP at low HFJV rates in larger patients
LOWER
- Keep at the minimum of 0.02 most of the time
- To increase exhalation time and lengthen I:E ratio
PEEP
RAISE
- To improve oxygenation and decrease delta P (~Tidal Volume)
- To find optimal PEEP (Raise PEEP until SaO2 stays constant when switching from IMV to CPAP)
LOWER
- When oxygenation is adequate and FiO2 is ≤ .40
CV Rate
RAISE
- To reverse atelectasis or dilate restricted airways (3-5 bpm) as a temporary recruitment maneuver
LOWER
- To minimize volutrauma, especially when air leaks are present
- To decrease hemodynamic compromise
- When increasing PEEP does not improve PaO2
- When MAP is having a negative affect on cardiac function
CV PIP
RAISE
- To reverse atelectasis (3-5 bpm) as a temporary recruitment maneuver
LOWER
- To minimize volutrauma, especially when air leaks are present
- To decrease hemodynamic compromise
CV I-time
RAISE
- To reverse atelectasis during a temporary recruitment maneuver
LOWER
- To minimize volutrauma, especially when air leaks are present
- To decrease hemodynamic compromise
General Guidelines
1. HFV ΔP (PIP - PEEP) is the primary determinant of PaCO2. HFV rate is secondary.
2. Resting lung volume (FRC supported by set PEEP) and mean airway pressure are crucial determinants of PO2.
3. Avoid hyperventilation and hypoxemia by using optimal PEEP. (See When to Raise PEEP below.)
4. Minimize IMV at all times, using very low rates (typically 0 – 3 bpm), unless IMV is being used to temporarily recruit collapsed alveoli. In general, keep IMV PIP 10 –
30% < HFV PIP.
5. To overcome atelectasis, IMV rates up to 5 bpm can be used for 10 – 30 minutes. Thereafter, IMV rate should be dropped back to 0 – 3 bpm. In general, keep IMV I-
time = 0.4 – 0.6 sec.
6. If lowering IMV rate worsens oxygenation, PEEP is probably too low. Higher PEEPs and lower IMV rates reduce the risk of lung injury.
7. Lower FIO2 before PEEP when weaning until FIO2 is less than 0.4.