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Targeting supernormal frequencies and very low tidal volumes in high-frequency oscillatory ventilation: can ‘volume guarantee’ deliver?

Journal of Perinatology volume 36, page 794 (2016)Cite this article

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In a recent paper, González-Pacheco et al.1 demonstrated that it is possible to achieve very low-tidal volumes using combined high-frequency oscillatory ventilation (HFOV) and volume guarantee (VG) mode in Drager Babylog VN500 ventilator (Dräger Medical, Lübeck, Germany). Unintended hyperventilation and CO2 wash-out remain pertinent issues in HFOV, especially in inexperienced hands, and hence, meticulously applied VG mode can potentially overcome the risks of hypocarbia, as well as volutrauma due to inadvertently high-tidal volume (VThf).2, 3 However, we would like to highlight the following points and seek response from the authors:

First, considering that it was a prospectively conducted experiment to test the feasibility of use of lower VThf, the context remains that the target group is premature and low-birth-weights babies. We find it intriguing that the authors recruited a heterogenous group including term as well as preterm infants. In fact, it is not clear whether term-born babies were ventilated also. This contention is more apparent when we consider that individual ventilator performance in term infants can differ from that in preterm infants and it is unknown whether low-tidal volume ventilation has any impact on short- and long-term outcomes in term-born.4

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References

  1. González-Pacheco N, Sánchez Luna M, Ramos Navarro C, Navarro Patiño N, de la Blanca A . Using very high frequencies with very low lung volumes during high-frequency oscillatory ventilation to protect the immature lung. A pilot study. J Perinatal 2016; 36: 306–310.

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Authors and Affiliations

  1. Department of Pediatrics, Oman Medical College, Sohar, Sultanate of Oman

    G P Prashanth & S K Ismail

  2. Department of Pediatrics and Neonatology, Sohar Regional Hospital, Sohar, Sultanate of Oman

    K Hebbal

Authors
  1. G P Prashanth
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  2. K Hebbal
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  3. S K Ismail
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Correspondence to G P Prashanth.

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Prashanth, G., Hebbal, K. & Ismail, S. Targeting supernormal frequencies and very low tidal volumes in high-frequency oscillatory ventilation: can ‘volume guarantee’ deliver?. J Perinatol 36, 794 (2016). https://doi.org/10.1038/jp.2016.101

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