Cardiopulmonary effects of high frequency positive-pressure ventilation versus jet ventilation in respiratory failure

Conventional ventilators are frequently used at high rates in the intensive care nursery to achieve adequate oxygenation and ventilation with reduced peak inspiratory pressure. The efficacy and limitations of high frequency positive-pressure ventilation (HFPPV) using a conventional ventilator were studied by comparing the cardiopulmonary effects of HFPPV with those of high frequency jet ventilation (HFJV) in an animal model of respiratory failure. Sixteen saline-lavaged rabbits were ventilated with either HFPPV or HFJV for 2 h using rates of 200 breaths/min, inspiratory to expiratory ratio of 1:2, and FIO2 of 1.0. As controls an additional eight lavaged rabbits were ventilated at conventional rates (40 to 60 breaths/min). Proximal peak inspiratory pressure as indicated on the ventilator manometer or drive pressure was adjusted to maintain acceptable blood gases. Cardiac output (CO) was measured by thermodilution. Although there was a significant decrease in cardiac function over time, there were no significant differences between the groups in CO or stroke volume. Satisfactory oxygenation and ventilation were maintained in all groups. Static respiratory system compliance and mean airway pressure were similar among the groups. Histologic examination of the lungs revealed no differences between the three ventilator groups. The results of this study indicate that both HFPPV and HFJV are effective in short-term maintenance of normal blood gases in respiratory failure without any discernable differences in their effects on cardiovascular function. At very high rates, however, increases in VT are not possible with HFPPV, which limits its usefulness and flexibility in respiratory failure.