Neonatal Nurse Practitioner Practice Exam

How much should the HFOV setting be increased until chest wiggle is observed?

1. 1-2 cmH2O

2. 2-4 cmH2O

3. 4-6 cmH2O

4. 5-7 cmH2O

The correct answer is: 2-4 cmH2O

In high-frequency oscillatory ventilation (HFOV), adjusting the settings requires careful consideration of the patient’s response to therapy. When clinicians are determining the appropriate increment for increasing the pressure settings until chest wiggle is observed, 2-4 cmH2O is the recommended range because it typically allows for a gradual increase that can effectively enhance ventilation without causing excessive trauma to the lungs. This adjustment helps in achieving an adequate level of ventilation while minimizing the risk of over-inflation or under-inflation. Observing chest wiggle indicates that the oscillations are sufficiently affecting the chest wall, which is an important clinical sign of effective ventilation. Increments below 2 cmH2O may be too conservative, potentially leading to inadequate ventilation, while increments higher than 4 cmH2O could risk overdistending the lungs, which is undesirable in managing neonatal respiratory distress. Therefore, 2-4 cmH2O provides a balanced approach to ensuring the effectiveness of HFOV settings while prioritizing patient safety.