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doi:10.1378/chest.06-1549
(Chest. 2007; 131:1907-1916)
© 2007 American College of Chest Physicians
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High-Frequency Oscillatory Ventilation for Adult Patients With ARDS*

Kenneth P. W. Chan, MBBS, MMed, FCCP; Thomas E. Stewart, MD and Sangeeta Mehta, MD

* From the Department of Respiratory and Critical Care Medicine (Dr. Chan), Singapore General Hospital, Singapore; and Interdepartmental Division of Critical Care Medicine (Drs. Stewart and Mehta), University of Toronto, Toronto, ON, Canada.

Correspondence to: Sangeeta Mehta, MD, Mt. Sinai Hospital, 600 University Ave, Room 18–216, Toronto, ON, Canada M5G 1X5; e-mail: geeta.mehta{at}utoronto.ca

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.

Key Words: acute lung injury • ARDS • high-frequency oscillatory ventilation • high-frequency ventilation • mechanical ventilation • respiratory failure • ventilator-induced lung injury






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Copyright © 2007 by the American College of Chest Physicians.