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Review
. 2019 May 2:55:40-46.
doi: 10.29390/cjrt-2019-004. eCollection 2019.

High-frequency oscillatory ventilation: A narrative review

Morgan Meyers  1 , Nathan Rodrigues  2 , Arzu Ari  2
Affiliations
Review

High-frequency oscillatory ventilation: A narrative review

Morgan Meyers et al. Can J Respir Ther. .

Abstract

High-frequency oscillatory ventilation (HFOV) is a lung-protective strategy that can be utilized in the full spectrum of patient populations ranging from neonatal to adults with acute lung injury. HFOV is often utilized as a rescue strategy when conventional mechanical ventilation (CV) has failed. HFOV uses low tidal volumes and constant mean airway pressures in conjunction with high respiratory rates to provide beneficial effects on oxygenation and ventilation, while eliminating the traumatic "inflate-deflate" cycle imposed by CV. Although statistical evidence supporting HFOV is particularly low, potential benefits for its application in many clinical manifestations still remain. High-frequency oscillation is a safe and effective rescue mode of ventilation for the treatment of acute respiratory distress syndrome (ARDS). All patients who have ventilator-induced lung injury (VILI) or are at risk of developing VILI or ARDS would be suitable candidates for HFOV, especially those who have failed conventional mechanical ventilation. This narrative aims to provide a review of HFOV vis-à-vis its indications, contraindications, hazards, parameters to monitoring, patient selection, clinical goals, mechanisms of action, controls for optimizing ventilation and oxygenation, clinical application in ARDS, and a comparison with other modes of mechanical ventilation.

Keywords: acute respiratory distress syndrome; clinical outcomes; high frequency oscillatory ventilation; oxygenation; ventilator induced lung injury.

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Conflict of interest statement

AA discloses relationship with the CHEST Foundation, Bayer Pharmaceuticals, Aerogen Ltd, ARC Medical and Sunovion Pharmaceuticals. NR and MM have no conflict of interest with regards to this article.

Figures

FIGURE 1
FIGURE 1. Care Fusion Oscillator 3100A: depicting oxygenation controls. (A) Mean airway pressure limit knob and (B) mean airway pressure adjustment knob. Note: the 3100B does not have a mean airway pressure limit knob; the monitor is located in the top left corner.
FIGURE 2
FIGURE 2. Care Fusion Oscillator 3100A: depicting ventilation controls. (A) Power control (amplitude) and (B) frequency (hertz).
FIGURE 3
FIGURE 3. Care Fusion Oscillator 3100A: depicting other important controls. (A) bias flow, (B) inspiratory time percent, (C) piston position and displacement, and (D) alarms.
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