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High Frequency Oscillatory Ventilation (HFOV)
- Although traditionally used in neonates, HFOV is becoming increasingly popular for select adult patients with ALI/ARDS.
- Benefits of HFOV include:
- use of smaller tidal volumes than conventional ventilation
- maintains alveoli open at a relatively constant airway pressure thereby preventing atelectrauma
- improves ventilation/perfusion
- Indications for use of HFOV are when:
- conventional ventilator settings require an FiO2 > 70% and PEEP > 14 cm H2O OR
- pH < 7.25 despite higher tidal volumes and plateau pressures > 30 cm H2O
- Key variables, along with suggested initial settings, for HFOV include:
- Frequency: 4 - 7 Hertz
- Amplitude: 70 - 90 cm H2O
- Mean airway pressure: 5 cm H2O greater than last plateau pressure measured on conventional setting
- Bias flow: 40 L/min
- Inspiratory time: 33%
- FiO2: 100%
References
Stawicki SP, Goyal M, Sarani B. High frequency oscillatory ventilation and airway pressure release ventilation: a practical guide. Journal of Intensive Care Medicine 2009:24(4):215-229.