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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 cmH
O. Readjust the bias flow to correct the mPaw level.
2
6. Initial FiO
at transition to HFOV may be set at 100%. Alternatively, increase
2
current FiO
by 10%.
2
Weaning from HFOV
1. As oxygenation improves, gradually wean FiO
mPaw 2 to 3 cmH
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 cmH
c. I:E approximately 1:1
d. PEEP approximately 12 cmH
e. Rate approximately 20 to 25 per minute
f. mPaw approximately 20 cmH
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O every 4 to 6 hours until mPaw is in a 22 to 24 cmH
2
O
2
O
2
O (+/- 2cmH
2
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to 40%, then slowly reduce
2
O)
2
O range.
2
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