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Abstract
High-frequency oscillatory ventilation (HFOV) is an established mode of respiratory support in the neonatal intensive care unit. Large clinical trial data is based on first intention use in preterm infants with acute respiratory distress syndrome. Clinical practice has evolved from this narrow population. HFOV is most often reserved for term and preterm infants with severe, and often complex, respiratory failure not responding to conventional modalities of respiratory support. Thus, optimal, and safe, application of HFOV requires the clinician to adapt mean airway pressure, frequency, inspiratory:expiratory ratio and tidal volume to individual patient needs based on pathophysiology, lung volume state and infant size. This narrative review summarises the status of HFOV in neonatal intensive care units today, the lessons that can be learnt from the past, how to apply HFOV in different neonatal populations and conditions and highlights potential new advances. Specifically, we provide guidance on how to apply an open lung approach to mean airway pressure, selecting the correct frequency and use of volume-targeted HFOV.
- Neonatology
- Respiratory Medicine
- Intensive Care Units, Neonatal
Data availability statement
All data, including raw data used for all figures and analysis, and allocation of specific subjects in previous published material are available upon request to the corresponding author from 3 months following article publication to researchers who provide a methodologically sound proposal, with approval by an independent review committee ('learned intermediary'). Proposals should be directed to david.tingay@mcri.edu.au to gain access. Data requestors will need to sign a data access or material transfer agreement approved by MCRI.
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Data availability statement
All data, including raw data used for all figures and analysis, and allocation of specific subjects in previous published material are available upon request to the corresponding author from 3 months following article publication to researchers who provide a methodologically sound proposal, with approval by an independent review committee ('learned intermediary'). Proposals should be directed to david.tingay@mcri.edu.au to gain access. Data requestors will need to sign a data access or material transfer agreement approved by MCRI.
Footnotes
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Contributors DGT developed the concept. JH analysed the clinical trial data. JH and DGT wrote the first draft except for ‘HFOV: how does it work’ section (JL and TS) and ‘Delivering Tidal Volume’ (JJP). All authors contributed to the content of each section and redrafting the manuscript.
Funding DGT is supported by a National Health and Medical Research Council Leadership Level 1 Investigator Fellowship (Grant ID 2008212). JJP is supported by a National Health and Medical Research Council Leadership Level 2 Investigator Fellowship (Grant ID 1196188). This study is supported by the Victorian Government Operational Infrastructure Support Program (Melbourne, Australia).
Competing interests DGT has presented on mechanical ventilation, including HFOV, at scientific meetings and workshops supported by mechanical ventilator manufacturers, including SLE Ltd UK and Vyaire Medical (formerly Sensormedics, Carefusion and Acutronic). DGT has not received payment for presentations or consultation and the ventilator manufacturers had no input into content of presentations or this manuscript. JL has ongoing collaboration with 4DMedicalR&D (Melbourne, Australia) developing computational models of flows in airways, including during mechanical ventilation. 4DMedicalR&D was not involved into the content of this manuscript. PR has presented on mechanical ventilation, including HFOV, at scientific meetings and workshops supported by mechanical ventilator manufacturers, including SLE Ltd UK and Vyaire Medical (formerly Sensormedics, Carefusion and Acutronic). He has ongoing consulting activity with Getinge and Metran. JJP has presented on mechanical ventilation, including HFOV at scientific meetings. She has ongoing consulting activity on behalf of her university to deliver webinars, and educational workshops supported by Draeger Medical and her research program has benefited from consumables provided as unrestricted research support from Fisher & Paykel Healthcare, Pari GmBH and Chiesi Farmaceutici S.p.A. MM has presented on mechanical ventilation, including HFOV, at workshops supported by SLE Ltd UK. The authors have no other competing interests to declare.
Provenance and peer review Not commissioned; externally peer reviewed.
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