Amplitude (ΔP): Set the amplitude ( ΔP) to approximately double the value of the MAP, sufficient to see a chest “wiggle” from the level of the nipple to the umbilicus.

In situations of severe gas trapping, or air leak, a lower MAP may be selected If Higher MAPs are required, for example in in severe lung disease with very poorly compliant lungs, then they should be used with caution and careful monitoring to avoid over distension and air leak.

Typical operating range for MAP will be between 10 to 16 cmH2O.

However, to achieve optimal lung recruitment the operator should be prepared to start a recruitment manoeuvre – see section 2.3.

Mean Airway Pressure (MAP): Generally the starting MAP is set 2-3cm above the current CMV mean airway pressure.

Initial settings will be prescribed by medical staff, however the following is a guide:

Consider invasive BP monitoring if possible.

If BP not improving after volume expansion, consider starting inotropic support. Consider volume expansion to avoid a sharp fall in cardiac output. Ensure blood pressure and intravascular volume is adequate before transferring to HFOV, as blood pressure may fall rapidly, especially in babies with perfusion problems in Sepsis / NEC.Please discuss the decision to commence HFOV with the attending consultant. Neonatal Air-leak Syndrome with pulmonary interstitial emphysema.Neonatal Respiratory Distress Syndrome (RDS).Particular disease settings where HFOV may be appropriate include lung disease in: Alternatively, HFOV may be employed to minimise lung injury by avoiding use of high inspiratory pressures or FiO 2 on CMV. HFOV may be reserved as a “rescue therapy” when adequate oxygenation and/or ventilation cannot be achieved on CMV. HFOV may be used as an alternative to conventional ventilation in a number of disease settings. 2.3 Adjusting the MAP for optimal lung recruitment – “Recruitment Manoeuvre”Ģ.7 Making Adjustments Once Established on HFOV

Amplitude of lung sounds