thx3

Hello! 1. We have used HFO + VG for some years in our unit. We very often use HFO from start in extremely preterm and not as rescue-treatment. Our experience is good and they tolerate HFO well. I find it easier to control pCO2 with mild permissive hypercapnia in HFO+VG compared to HFO or CV. I think it is definitely an option to use HFO in the first place. But you should make sure that you and the rest of the staff is on the same level there and do some reading first. The frequency in extremely premature babies should be 10-15. We usually start at 10 and probably beneficial to the smallest children to have higher frequencies. Initial setting of ΔP should be around 20-25cm H20 in a newborn ELBW, or titrate until you se discrete chest wall vibration. You would need higher amplitudes when using HFO as rescue. 2. The volumes usually are 1.5-3ml/kg but depend on Hz (higher volumes for lower Hz and vice versa). I find the easiest way to apply VG is to "lock" the volume when you have a blood gas with pCO2 with mild permissive hypercapnia. Set the ΔPmax about 5cmH20 above the setting that you had with VG turned off. The reason why the ventilator starts beeping is that the ΔP is not high enough to allow for the volume requested. So for the patient you describe I would set Hz to 10-12 and the volume should be around 2/kg. Hz in the area 5-10 you should reserve for patients with meconium aspiration syndrome, PPHN and other term babies. 3. Dräger has a brochure on HFO that I find quite good, that covers the theoretical background of HFO and settings, and practical tips. It is available to download. We don´t have Dräger in our unit but their brochure is good.