What should be set as the mean airway pressure when initiating high frequency oscillatory ventilation for a preterm infant?

When initiating high-frequency oscillatory ventilation (HFOV) for a preterm infant, it is essential to set the mean airway pressure (MAP) correctly to ensure that adequate lung inflation and oxygenation are achieved without causing barotrauma. Setting the MAP 10-20% lower than the peak inspiratory pressure (PIP) on pressure control is appropriate because it allows for effective lung recruitment while minimizing the risk of overdistension.

In HFOV, the goal is to maintain sufficient lung volume and effectively recruit collapsed or underinflated alveoli while allowing for gentle ventilation that avoids the high pressures associated with traditional ventilation methods. By setting the MAP lower than the PIP, clinicians can ensure that the distending pressure within the lung is maintained at a safe level, promoting adequate oxygenation and ventilation without causing harm to the infant's delicate lung tissue.

The fundamental principle in using HFOV is to carefully balance lung recruitment with safe pressure limits; thus, utilizing a MAP that is proportionally lower than the PIP on pressure control achieves this balance effectively.