A system for high-frequency oscillatory ventilation and intermittent mandatory ventilation in neonates.

We combined high-frequency oscillatory ventilation and intermittent mandatory ventilation, using a system composed of an Emerson airway vibrator, a Babybird 1 ventilator, and rate/pressure monitors. The Emerson device, a modified air compressor with rate controller, oscillated a small volume of gas at the airway. This device was coupled to the bird unit through a circuit of our design. Humidified fresh gas and pressure-relief valves were provided by the bird ventilator, and mean airway pressure was adjusted by its expiratory-limb venturi device or by the end-expiratory pressure control. The volume of gas delivered by the oscillator to various sites was measured with a plethysmograph tuned to high frequencies. At frequencies of 20 to 30 Hz, a 27-ml volume from the oscillator decreased to between 7 and 14 ml at the proximal airway, and to between 0.1 and 2.3 ml at the distal tip of the endotracheal tube. The magnitude of this decrease depended on the size of the endotracheal tube, the circuit resistance of the ventilator, oscillation frequency, and the position of the oscillator's expansion-chamber valve. We have used this system for over 3 yr to ventilate sick neonates safely and effectively.