High Frequency Oscillation

(HFO)
Servo-n
2 Ser vo -n HFOV pocket guide
Contents

Introduction 4

Servo-n HFOV operating principle 5

Y sensor 6

Getinge HFO patient circuit 8

Patient circuit test 10

Servo-n user interface 11

HFOV settings 12

HFO 15

HFO (V TGT) 17

Pause oscillation 21

Terminology 23

Ser vo -n HFOV pocket guide 3

Introduction
High frequency oscillatory ventilation (HFOV) is a type of mechanical
ventilation that uses a constant distending pressure: mean airway pressure
(Pmean) with pressure variations oscillating around the Pmean at very high
rates.

HFOV implies ventilation with frequencies in the range 5–20 Hz. The high
frequency tidal volume (VTHF) is ideally 1–3 ml/kg.

In Servo-n, high frequency HFOV is available in two modes:

• HFO Pressure amplitude control
• HFO (VTGT) Volume target

HFOV delivers a pressure signal with:

• a mean airway pressure of Pmean (cmH₂O) at the Y piece
• a peak-to-peak amplitude required to deliver a high frequency tidal volume
of VTHF (ml) at the Y piece
• a ratio between inspiratory and expiratory flow durations of I:EHF
• an oscillation frequency of f (oscillation frequency f is expressed in Hz),
i.e. with a cycle duration of 1/f (s)

Y-piece pressure Mean airway

amplitude pressure

Lung
pressure
amplitude

4 Ser vo -n HFOV pocket guide

Servo-n HFOV
operating principle
Inertia powered HFOV
Both positive and negative pressures are created using standard gas
chain. The inertia of the air, together with fast and well-synchronized
control of valves creates the negative pressure.

The servo controller system, senses and adjusts gas delivery

extremely fast and accurate. Transducer refresh rate is 2000 times
per second. This will lead to immediate response to patient efforts,
smooth uninterrupted regulation during inhalation and a low
resistance during exhalation.

5
Y sensor
The Y sensor module should be connected during HFOV, since it enables
measurement of volumes and mean pressure at the Y piece.

In other modes it is recommended to use Y sensor for tidal volumes below

5 ml to increase the accuracy of gas delivery and monitoring. Y sensor
measurement is not needed in NAVA mode.

When a new calibration is needed, a dialog appears on the screen

with instructions.

6 Ser vo -n HFOV pocket guide

 Y sensor and pressure line

Pressure line connection

on Getinge HFOV circuit.

Note: For the F&P circuit,

that is used with the
F&P950 humidifier, the
pressure line connection
point is on the expiratory
limb of the circuit.

The pressure line is needed during

HFOV modes. In other modes the
pressure line is not needed. If you
forget to connect the pressure line
a message and alarm will
be activated.

Ser vo -n HFOV pocket guide 7

Getinge HFO patient circuit
It is recommended to use the Getinge HFO patient circuit to obtain the
maximum power performance of Servo-n HFOV. Using a non-recommended
patient circuit will decrease the power of HFOV. This may lead to using higher
amplitude settings and lower frequency to achieve the desired high frequency
tidal volume and maintain acceptable ventilation.

The HFOV patient circuit is also suitable for all types of ventilation including
conventional, non-invasive and High Flow therapy.

Patient circuit recommended for Servo-n HFOV to enhance the power during high
frequency oscillation.

Note:
• The Getinge HFOV circuit is used with the MR850 humidifier. When
using the F&P950 humidifier a dedicated F&P circuit must be used.
This circuit can be used with expiratory filter heater, but not with the
expiratory water trap.
• The 15 mm dual heated HFOV neonatal patient circuit can be used
for all ventilation modes.
• It is recommended to use a thermoshell on the expiratory inlet.

8 Ser vo -n HFOV pocket guide

 Mounting the thermoshell Emptying the water trap

The water trap is placed on the expiratory inlet. The water trap can be emptied
without affecting the ventilation to the patient. By also adding the thermoshell
on the expiratory inlet the risk of condensate in the circuit will be reduced.

Ser vo -n HFOV pocket guide 9

Patient Circuit test (PCT)
CAUTION: The patient circuit test must be performed with a complete patient
circuit, including all accessories (e.g active humidifier filled with water and
water trap).

IMPORTANT: The active humidifier and the expiratory filter heater must be
turned off during the patient circuit test. The Y sensor does not need to be
connected when performing the PCT.

Important reminder:
If the patient circuit or accessories have been added or removed and no new
patient circuit test is performed:
• The ventilator will compensate incorrectly based on the measurements of
the previous patient circuit.
• In HFOV, mean pressure delivery and presented mean pressure estimations
will be incorrect, volumes delivered to the patient are restricted and alarms
falsely triggered.

Suctioning during HFOV

Closed suctioning can be performed in HFOV, but will impact volume
measurement and delivered amplitude in HFO (V TGT). If suctioning is to be
performed in HFO (V TGT) while maintaining appropriate amplitudes, it is
necessary to:
• set tight pressure amplitude limits to maintain appropriate amplitudes or
• perform suctioning during a pause oscillation maneuver.

10 Ser vo -n HFOV pocket guide

 Servo-n user interface
1

2
7

4
5

1.1 PATIENT DATA – here you can enter patient’s weight.

2 Y SENSOR active, if inactive the Y symbol is crossed out.
2.
3 DC0₂ is the CO₂ diffusion coefficient.
3.
4.
4 VTHF measured high frequency tidal volume.
5 O₂ BOOST – when tapped, O₂ boost delivers the oxygen setting displayed
5.
here for a period of 1 minute. The O₂ boost level can be changed under
maneuvers. The value entered under O₂ boost (%) level specifies the
number of percentage units that will be added to the value set for the O₂
concentration. All alarms will be silenced for 1 minutes when O₂ boost
is activated.
6 Pmean – the mean airway pressure, is superimposed on the pressure
6.
waveform during HFOV.
7 Some functions are not available in HFOV like DISCONNECTION support.
7.

Ser vo -n HFOV pocket guide 11

HFOV settings
Pmean
Mean airway pressure (cmH₂0).

Pampl
Pressure amplitude (cmH₂0).

Frequency
High frequency respiratory rate (Hz = cycles per second,
i.e. 10Hz =10 cycles/sec = 600 cycles/min).

I:EHF
Ratio between inspiratory and expiratory flow durations.
In HFOV, an I:EHF ratio of 1:2 will yield a higher minimum pressure
during the expiratory phase than an I:EHF ratio of 1:1. This makes
the airways less likely to collapse.

12 Ser vo -n HFOV pocket guide

Safety scales
The bar displays the safety scale that is the range that is safe to use for most
patients. If a setting is outside the normal range the color changes. The safety
scale can be expanded by tapping .

Contextual help
Most of the settings have contextual help to guide you.

Note:
The following colors are used for settings:
RED Not recommended
YELLOW Use with caution
GREEN Normal

Ser vo -n HFOV pocket guide 13

Tap on the waveforms to change the scale of the waveforms.

Tap on the arrow to open the short trends.

14 Ser vo -n HFOV pocket guide

HFO
The following parameters to set:
• Oxygen concentration
• Pmean
• Pampl
• f
• I:EHF

EXAMPLE: If PC is used prior the HFO, the Pmean used there, plus an
additional 2 cmH₂O, will be proposed as the Pmean setting for HFO.

Ser vo -n HFOV pocket guide 15

High Frequency Oscillation (HFO) mode, pressure amplitude control.

In HFO the high frequency tidal volume (VTHF) alarm is set.

16 Ser vo -n HFOV pocket guide

HFO (V TGT)

HFO (V TGT) is a high frequency volume targeting ventilation mode.

The following parameters to set in HFO (V TGT):

• Oxygen concentration
• Pmean
• VTHF
• f
• I:EHF

Ser vo -n HFOV pocket guide 17

In HFO (V TGT) the volume is set. Note that ml/kg is displayed here.

If the Y flow sensor is disconnected from the Y sensor module, the ventilator
system will automatically switch to backup ventilation (HFO).

NOTE: During Backup HFO, a Backup Pampl parameter can be adjusted.

18 Ser vo -n HFOV pocket guide

The pressure amplitude is limited by the upper alarm limit that is set.

EXAMPLE: If the Y flow sensor is disconnected from the patient circuit during
HFO (V TGT), the resulting Pampl increase will not be allowed to exceed
the upper Pampl alarm limit. It is important to set the amplitude alarm
appropriately, when the patient's lung condition changes the user will then be
informed.

HFO (V TGT) is not suitable when the patient is vigorously breathing

spontaneously. It will activate frequent volume alarms.

Ser vo -n HFOV pocket guide 19

The HFO (V TGT) mode can be used to maintain stable VTHF delivery, by
matching required amplitude to changes in compliance. Monitor and record
the amplitude achieved, Servo-n displays this as Pampl on the screen.

During HFO (V TGT) mode shows how to set the volume target per body weight.

Edi monitoring during HFOV

Edi
The Edi signal can be monitored during HFOV.

20 Ser vo -n HFOV pocket guide

Pause oscillation
The Pause oscillation maneuver pauses the oscillation but maintains the Pmean.
Tap and hold PAUSE OSCILLATION to activate the pause. Oscillations may be
paused for up to 20 seconds.

Tap RESUME
OSCILLATION
to end the
pause time.

Ser vo -n HFOV pocket guide 21

22
Terminology

Pmean (cmH₂O) Mean airway pressure (cmH₂O).

Amplitude A peak-to-peak amplitude of Pampl (cmH₂O) at the

inspiratory outlet a ratio between inspiratory and
expiratory flow durations of I:E HF around the Pmean.

Edi Electrical diaphragm activity.

Frequency High frequency oscillation ventilation rate.

Frequency, f (Hz) where ; (Hz = cycles per second,
i.e. 10Hz = 10 cycles/sec = 600 cycles/min).

HFO (VTGT) High Frequency Oscillation Volume Target Ventilation.

VTHF High frequency tidal volume.

I:E HF A ratio between inspiratory and expiratory flow

durations of I:EHF.

DCO₂ The CO₂ diffusion coefficient or DCO₂ is calculated as

f * VTHF2 and it is proportional to ventilation or CO₂
washout during HFO ventilation.

Oxygenation Oxygenation is dependent on MAP and FiO₂. MAP provides

a constant distending pressure equivalent to CPAP.
This inflates the lung to a constant and optimal lung volume
maximizing the area for gas exchange and preventing
alveolar collapse in the expiratory phase.

Ventilation In HFOV, oxygenation can be separated from ventilation,

as they are not dependent on each other as is the case with
conventional ventilation. Ventilation or CO₂ elimination is
dependent on amplitude and to a lesser degree frequency.

Disclaimer: The clinical management on HFOV stated in this guideline is

a general practice guideline. It may differ in every Neonatal ICU. HFOV
should be managed under a physician's order. This guide is referring to
Servo-n® 4.4 ventilator.

Ser vo -n HFOV pocket guide 23

 © Maquet Critical Care AB 2020 · Servo-n are trademarks of Getinge or any of its subsidaries · mx-8605 Rev01 · English

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