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Non-invasive high-frequency oscillatory ventilation in neonates: review of physiology, biology and clinical data
  1. Daniele De Luca1,2,
  2. Valentina Dell'Orto1
  1. 1Division of Paediatrics and Neonatal Critical Care, APHP, South Paris University Hospitals, Medical Centre “A.Béclère”, Paris, France
  2. 2Institute of Anaesthesiology and Critical Care, Catholic University of the Sacred Heart, Rome, Italy
  1. Correspondence to Dr Daniele De Luca, Service de Réanimation Néonatale, GHU Paris Sud, Hopital “A.Béclère”, 157 rue de la Porte de Trivaux, Clamart, Paris 92140, France; dm.deluca{at}


Non-invasive high-frequency oscillatory ventilation (NHFOV) consists of the application of a bias flow generating a continuous distending positive pressure with superimposed oscillations, which have constant frequency and active expiratory phase. NHFOV matches together the advantages of high-frequency ventilation (no need for synchronisation, high efficacy in removing CO2) and nasal continuous positive airway pressure (CPAP) (non-invasive interface, increase in functional residual capacity allowing oxygenation to improve). There is enough clinical expertise demonstrating that NHFOV may be tried in some selected cases, in whom CPAP or conventional non-invasive ventilation have failed. Nonetheless, there are no clear data about its clinical usefulness and there is a need for randomised controlled studies. Our purpose is to review the physiology and biological effects of NHFOV, to present the current clinical evidence on its use, to provide some guiding principles to clinicians and suggest directions for further research.

  • high frequency oscillatory ventilation
  • HFOV
  • Neonatology
  • neonate
  • nasal
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  • Contributors DDL wrote the first paper draft and no honorarium was provided for that. DDL conceived the paper and both the authors participated in its preparation. DDL provided and analysed data from previous unpublished bench experiments. VDO performed bibliographic research and both the authors analysed the literature data. VDO also provided and prepared clinical data of illustrative case and took care of the online supplementary video contents. Both the authors reviewed the manuscript for important intellectual contents and approved the final version.

  • Competing interests None declared.

  • Patient consent Parental/guardian consent obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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