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High-Frequency Ventilation for Acute Lung Injury and ARDS^*

^* From the Department of Medicine, Johns Hopkins University, Baltimore, MD.

Correspondence to: Jerry A. Krishnan, MD, Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, 600 N Wolfe St, Baltimore, MD 21287; e-mail: satish{at}welch.jhu.edu

In patients with acute lung injury (ALI) and ARDS, conventional mechanical ventilation (CV) may cause additional lung injury from overdistention of the lung during inspiration, repeated opening and closing of small bronchioles and alveoli, or from excessive stress at the margins between aerated and atelectatic lung regions. Increasing evidence suggests that smaller tidal volumes (VTs) and higher end-expiratory lung volumes (EELVs) may be protective from these forms of ventilator-associated lung injury and may improve outcomes from ALI/ARDS. High-frequency ventilation (HFV)-based ventilatory strategies offer two potential advantages over CV for pateints with ALI/ARDS. First, HFV uses very small VTs, allowing higher EELVs with less overdistention than is possible with CV. Second, despite the small VTs, high respiratory rates during HFV allow the maintenance of normal or near-normal PaCO₂ levels. In this review, the use of HFV as a lung protective strategy for patients with ALI/ARDS is discussed.

Key Words: acute lung injury • ARDS • barotrauma • high-frequency ventilation • high-frequency positive-pressure ventilation • high-frequency jet ventilation • high-frequency oscillation • mechanical ventilation • volutrauma

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