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BACKGROUND: The performance of high-frequency oscillatory ventilators (HFOV) differs by the waveform generation mode and circuit characteristics. Few studies have described the performance of piston-type HFOV. The present study aimed to compare the amplitude required to reach the target high-frequency tidal volume (VT); determine the relationship between the settings and actual pressure in amplitude or mean airway pressure (Paw); and describe the interaction among compliance, frequency, and endotracheal tube (ETT) inner diameter in 4 HFOV models, including Humming X, Vue (a piston type ventilator commonly used in Japan), VN500 (a diaphragm type), and SLE5000 (a reverse jet type). METHODS: The oscillatory ventilators were evaluated by using a 50-mL test lung with 0.5 and 1.0 mL/cm H2O compliance, Paw of 10 cm H2O, frequency of 12 and 15 Hz, and ETT inner diameters 2.0, 2.5, and 3.5 mm. At each permutation of compliance, frequency, and ETT, the target high-frequency VT was increased from 0.5 to 3.0 mL. The change in Paw from the ventilator (ventilator Paw) to Y-piece (Y Paw) and alveolar pressure (alveolar Paw) and the change in amplitude from the ventilator (ventilator amplitude) to Y-piece (Y amplitude) and alveolar pressure (alveolar amplitude) were determined at high-frequency VT of 1.0 and 3.0 mL. RESULTS: To achieve the target high-frequency VT, the Humming X and Vue required a higher amplitude than did the SLE5000, but the maximum amplitude in the VN500 was unable to attain a larger high-frequency VT. Ventilator Paw and alveolar pressure decreased at the Y-piece with the Humming X and Vue but increased with the SLE5000. The ventilator Paw in the VN500 decreased remarkably at a frequency of 15 Hz. The ventilator amplitude in all 4 ventilators decreased while temporarily increasing at the Y-piece in the VN500. CONCLUSIONS: The actual measured value, such as alveolar Paw and high-frequency VT, varied according to the type of HFOV system and the inner diameter of the ETT, even with identical settings. Clinicians should therefore determine the setting appropriate to each HFOV model. [ABSTRACT FROM AUTHOR]

An editorial is presented on the Treatment for congenital diaphragmatic hernia. Topics discussed include Modern treatment of Congenital diaphragmatic hernia (CDH) has steadily progressed by improved understanding and better management of deranged cardiopulmonary physiology and recognition of the role of delayed surgical repair; and the improvement of survival rate(s) of CDH is attributed to increasing prenatal diagnosis (%), emergent intubation at birth, gentle ventilation.