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High-Frequency Oscillatory Ventilation for ARDS?
- High-frequency oscillatory ventilation (HFOV) is increasingly utilized for adult patients with ARDS who remain hypoxemic despite optimal settings of conventional mechanical ventilation (CMV).
- HFOV maintains a constant mean airway pressure and delivers very small tidal volumes (1-3 ml/kg) at very high respiratory rates (frequency range up to 10 Hz).
- Potential advantages to HFOV over CMV include greater alveolar recruitment, prevention of atelectrauma, and limiting excess alveolar distension (i.e. volutrauma).
- Studies on HFOV in adults are not as numerous as those in neonates. As a result, optimal timing for initiation of HFOV is unclear.
- Nevertheless, some recommend considering HFOV for patients who persistently need an FiO2 > 60% with at least 10 cm H2O of PEEP on CMV.
- Due to the ventilator settings, patients receiving HFOV often require significant sedation and often neuromuscular blockade.
References
Ip T, Mehta S. The role of high-frequency oscillatory ventilation in the treatment of acute respiratory failure in adults. Curr Opin Crit Care 2012; 18:70-9.