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, the mean airway pressure (MAP) should typically be set at a level that is lower than the peak inspiratory pressure (PIP) used during pressure control ventilation. This is because the primary goal of HFOV is to maintain adequate ventilation and oxygenation while minimizing the risk of lung injury.

Setting the mean airway pressure 10-20% lower than the PIP allows for optimized alveolar recruitment and improved gas exchange. It helps to avoid overdistension of the alveoli that can occur with higher pressures while still ensuring that adequate oxygenation is maintained.

This approach takes into account the unique mechanics of HFOV, where the oscillations provide ventilation without the need for higher pressures that are commonly used in conventional ventilation strategies. Effective management of MAP is crucial to ensure that the infant's lungs remain compliant and that ventilation-perfusion mismatch is minimized, particularly in preterm infants who are at risk for respiratory distress syndrome and other complications.