High-Frequency Oscillatory Ventilation for Adult Patients With ARDS

Abstract

High-frequency oscillatory ventilation (HFOV) is characterized by the rapid delivery of small tidal volumes (Vts) of gas and the application of high mean airway pressures (mPaws). These characteristics make HFOV conceptually attractive as an ideal lung-protective ventilatory mode for the management of ARDS, as the high mPaws prevent cyclical derecruitment of the lung and the small Vts limit alveolar overdistension. In this review, we will summarize the literature describing the use of HFOV in adult patients with ARDS. In addition, we will discuss recent experimental studies of HFOV that have advanced our understanding of its mechanical properties. We identified 2 randomized controlled trials (RCTs) and 12 case series evaluating HFOV in adults with ARDS. In these studies, HFOV appears to be safe and consistently improves oxygenation when used as a rescue mode of ventilation in patients with severe ARDS. The two RCTs comparing HFOV to conventional ventilation revealed encouraging results but failed to show a mortality benefit of HFOV over conventional ventilation. Further research is needed to identify optimal patient selection, technique, the actual Vt delivered, and the role of combining HFOV with other interventions, such as recruitment maneuvers, prone positioning, and nitric oxide.

Intermittent recruitment with high-frequency oscillation/tracheal gas insufflation in acute respiratory distress syndrome

“…H igh-frequency oscillation (HFO) is suggested for adults with severe acute respiratory distress syndrome (ARDS) [1,2]. During HFO, tidal volumes of ,3.5 mL?kg -1 predicted body weight are administered at o3 Hz and mean airway pressure (P aw) ranges 22-40 cmH 2 O [1][2][3].…”

“…During HFO, tidal volumes of ,3.5 mL?kg -1 predicted body weight are administered at o3 Hz and mean airway pressure (P aw) ranges 22-40 cmH 2 O [1][2][3]. Animal lung injury data favour HFO over lung-protective conventional mechanical ventilation (CMV) [4].…”

“…Animal lung injury data favour HFO over lung-protective conventional mechanical ventilation (CMV) [4]. The low HFO tidal volumes minimise volutrauma and the high HFO P aw limits atelectrauma [2,5].…”

“…o6 h) and repetitive (according to pre-specified criteria) recruitment sessions of HFO-TGI with RMs could result in a progressively sustained oxygenation improvement, with minimal concurrent risk of long-term HFO-TGI-related adverse effects [2,7,10]. This should enable rapid reduction of subsequent CMV pressures to noninjurious levels [11].…”

High-Frequency Oscillatory Ventilation for Rescue From Refractory Hypoxemia in a Patient With Transfusion-Related Acute Lung Injury

“…Some studies of HFOV use for adult ARDS patients with severe hypoxemia and high plateau airway pressures have verified significant improvement in oxygenation and suggest that early initiation may have better outcomes. 3,4,19 It has also been shown that HFOV is effective and safe in correcting oxygenation failure associated with ARDS in surgical patients. 20 In this severe TRALI case, severe hypoxemia persisted despite pressure control ventilation support with 100% oxygen and PEEP of 18 cm H 2 O for 12 hours.…”