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9. Circulatory abnormalities (reduced systemic or pulmonary venous return, hypotension,
tachycardia, bradycardia, reduced cardiac output, excessive variability of blood
pressure);
Maintenance of an adequate airway is paramount in the infant or child undergoing high-
frequency oscillatory ventilation. The following points should be stressed in airway
management on units employing HFOV:
10. The largest endotracheal tube should be used which is compatible to that patient;
11. Chest wall “bounce” (vibrations of chest wall caused by HFOV) should be verified
regularly as part of nursing care;
12. Transcutaneous carbon dioxide measurement or frequent arterial blood gas samples
must be employed to alert the users to any change in patient condition.
The minimum patient monitoring requirements for HFOV are:
13. ECG/heart rate.
14. Chest wall movement.
15. Blood pressure (either by invasive or non invasive means).
16. Oxygen saturation.
17. Transcutaneous carbon dioxide arterial / capillary blood sampling.
18. Regular chest X-rays to verify efficiency of HFOV.
19. Regular cranial ultrasound examinations (in the newborn).
20. Standard nursing care for Intensive Care patients.
21. Special care should be taken when ventilating using HFOV during the administration of
natural surfactant to avoid "foaming" of surfactant in the lung and subsequent
deterioration.
22. When switching from conventional to high-frequency ventilation, or vice-versa,
alterations in ventilator settings and inspired oxygen concentrations may be required.
23. Exposing a baby to elevated concentrations of oxygen may lead to Retrolental
Fibroplasia (retinopathy of prematurity).
24. HFOV should only be instituted by fully trained and experienced medical personnel.
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