High frequency oscillatory and conventional mechanical ventilation in experimental surfactant deficiency: a study using a new infant ventilator technique.

The performance of a new infant ventilator system had to be evaluated. Technically it is characterized by flow (V)- and pressure (P)-transducers mounted immediately near the endotracheal tube. A microcomputer works as a function generator and governs servo-controllers for V and P thus offering a multiplicity of different modes both of the conventional (CMV) and high frequency oscillatory (HFO) type. The additional dead space imposed by the system is identical with its internal compressible volume of 2 ml. Serial pulmonary lavages were performed in 17 adult rabbits while on CMV. PaO2 per unit of mean airway pressure (MAP) decreased thereby from 95.9 +/- 29.3 to 9.0 +/- 6.7 (kPa/kPa). The animals were then alternately ventilated by HFO (5, 10, or 20 Hz) and CMV, at matched MAP's. No significant difference in PaO2 between the two methods was revealed in intra-animal comparisons except a slight superiority of CMV at MAP's above 1.7 kPa (P less than 0.05). There was no clear linear relationship between PaO2 and MAP both at CMV and HFO. A strong increase in PaO2 often occurred beyond a MAP threshold. In 37 postlavage HFO runs at 5 Hz in 13 animals volume amplitudes of 3.19 +/- 0.5 ml/kg of bodyweight resulted in PaCO2 levels of 6.29 +/- 1.87 kPa. Except in one experiment (10 Hz) volume amplitudes below the natural dead space produced arterial hypercapnia.