On all patients placed on HFOV, it is crucial that oxygen is flowing to the patient. By convention, in the United States oxygen tubing and cylinders are color-coded green. Pressurized air is color-coded yellow, and contains only 20.9% oxygen, the same as room air. Most HFOV ventilators display the amplitude and frequency. While an unexplained rise in amplitude can suggest that the endotracheal tube is becoming obstructed, a sudden decrease in amplitude can suggest pneumothorax. Examining the ventilator tubing can sometimes reveal secretions or hemoptysis. When examining the patient, a decrease in the patient’s chest wiggle can suggest pneumothorax, and a prompt chest x-ray should be performed. Although suctioning and bronchoscopy can cause derecruitment, they can be very important in managing the patient on HFOV. Care should be taken to minimize the duration of suctioning and bronchoscopy, and recruitment maneuvers might be considered following any interruption in HFOV.
Routine measures such as obtaining chest x-rays and performing physical examinations are not contraindicated while the patient is on HFOV. Temporarily stopping the piston allows for auscultation of the patient’s heart, but stoppage should be minimized. Patients can be moved for imaging studies without stopping HFOV. Daily nursing care remains unaffected. Measures to ensure adequate sedation such as a Bispectral Index Sensor (BIS) monitor should be in place if an infusion of neuromuscular blocking agent is being used as well as routine train-of-four monitoring to minimize the side effects of neuromuscular blockade.