Does high-frequency ventilation offer benefits over conventional ventilation in adult patients with acute respiratory distress syndrome?

Henry E. Fessler, Dean R. Hess

Research output: Contribution to journalArticle

Abstract

High-frequency ventilation is the application of mechanical ventilation with a respiratory rate > 100 breaths/min. High-frequency oscillatory ventilation (HFOV) is the form of high-frequency ventilation most widely used in adult critical care. The principles of lung-protective ventilation have matured in parallel with the technology for HFOV. The 2 basic principles of lung-protective ventilation are the use of small tidal volume and maintenance of adequate alveolar recruitment. Research in animal models and humans demonstrate that HFOV can support gas exchange with much smaller tidal volume than can be achieved with conventional ventilation. HFOV also provides more effective lung recruitment than conventional mechanical ventilation. However, at present, evidence is lacking that survival in adults with acute respiratory distress syndrome is improved by HFOV. Although HFOV may improve PaO2 in some patients, this improvement is often transitory. Available evidence does not support that pulmonary inflammation is reduced with HFOV in adult acute respiratory distress syndrome. Heavy sedation and often paralysis are necessary. The promise of HFOV as a lung-protective ventilation strategy remains attractive, but additional clinical trials are needed to determine whether this approach is superior to lung-protective ventilation with conventional mechanical ventilation.

Original languageEnglish (US)
Pages (from-to)595-605
Number of pages11
JournalRespiratory care
Volume52
Issue number5
StatePublished - May 1 2007

Keywords

  • Acute lung injury
  • Acute respiratory distress syndrome
  • High-frequency oscillatory ventilation
  • High-frequency ventilation
  • Lung-protective ventilation
  • Mechanical ventilation

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine
  • Critical Care and Intensive Care Medicine

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