Join Dr. John Lin, a pediatric critical care expert and director at St. Louis Children’s Hospital, as he delves into the innovative world of high-frequency percussive ventilation (HFPV). He discusses its key benefits for pediatric patients, especially those with complex respiratory issues, and shares insights on patient selection and collaborative care. Listeners will explore the advantages of HFPV over traditional methods, the importance of training for medical teams, and the future directions for research in this vital area of pediatric medicine.
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Stepwise Institutional Rollout
Dr. John Lin described how St. Louis Children's Hospital implemented the VDR with multidisciplinary training and close in-person support for the first six months.
They started with carefully selected patients and provided hands-on RT and physician education to ensure sustained success.
insights INSIGHT
How The VDR Works
The VDR (Volume Diffusive Respirator) combines pressure-control background breaths with IPV-style high-frequency percussive beats via a Phasotron device at the ET tube.
It relies on passive exhalation and delivers sub-tidal percussive volumes superimposed on pressure-controlled ventilation.
insights INSIGHT
Two Core Advantages Of HFPV
HFPV offers two main advantages: continuous airway clearance from percussive forces and enhanced CO2 clearance at lower mean airway pressures.
It augments convective and diffusive gas exchange and increases central airway washout through turbulent flow.
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By the end of this two-part series, listeners should be able to discuss:
The physiologic rationale supporting the use of high-frequency percussive ventilation (Volumetric Diffusive Respiration, or HFPV).
Patient populations most likely to benefit from HFPV.
Key published evidence that informs our use of HFPV in pediatric critical care.
An expert approach to managing a patient with HFPV.
Next steps in research that will direct our understanding of the use of HFPV in pediatric critical care.
About our Guest:
Dr. John Lin is a Professor of Pediatrics at Washington University in St. Louis. He serves as the Critical Care Fellowship Program Director and Medical Director of Respiratory Care at St. Louis Children’s Hospital. His academic interests are aimed at the implementation of specific task-based processes and systems-based interventions that increase team performance.
References:
Butler AD, Dominick CL, Yehya N. High frequency percussive ventilation in pediatric acute respiratory failure. Pediatr Pulmonol. 2021 Feb;56(2):502-508. doi: 10.1002/ppul.25191. Epub 2020 Dec 8. PMID: 33258557; PMCID: PMC7902396.
Linda Melchor. (2021, July 22). High-Frequency Percussive Ventilation – Using the VDR, or HFPV-4. Criticalcarenow.Com.
Salim, A., & Martin, M. (2005). High-frequency percussive ventilation. Critical Care Medicine, 33(Supplement), S241–S245. https://doi.org/10.1097/01.CCM.0000155921.32083.CE
Dominick, C., Nickel, A. J., & Yehya, N. (2022). High Frequency Percussive Ventilation in Viral Bronchiolitis: Do We Need a Standardized Approach to HFPV Management? Https://Home.Liebertpub.Com/Rcare, 67(7), 893–894. https://doi.org/10.4187/RESPCARE.10247
White, B. R., Cadotte, N., McClellan, E. B., Presson, A. P., Bennett, E., Smith, A. G., & Aljabari, S. (2022). High-Frequency Percussive Ventilation in Viral Bronchiolitis. Respiratory Care, 67(7), 781–788. https://doi.org/10.4187/respcare.09350
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Thank you for listening to this episode of PedsCrit. Please remember that all content during this episode is intended for educational and entertainment purposes only. It should not be used as medical advice. The views expressed during this episode by hosts and our guests are their own and do not reflect the official position of their institutions. If you have any comments, suggestions, or feedback-you can email us at pedscritpodcast@gmail.com. Check out http://www.pedscrit.comfor detailed show notes. And visit @critpeds on twitter and @pedscrit on instagram for real time show updates.
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