High-frequency ventilation☆,☆☆,★
Section snippets
TYPES OF HIGH-FREQUENCY VENTILATION AND HOW THEY ARE ADJUSTED
There are several types of HFV: high-frequency oscillatory ventilation, high-frequency jet ventilation, high-frequency flow interruption, high-frequency positive-pressure ventilation, and hybrids. Each type of high-frequency ventilator and the specific strategies suggested for its safe use are unique; published results on the use of one type of HFV cannot be generally applied. Most of the data on the use of HFV in the United States has involved one of five high-frequency devices or one of its
Oxygenation
Strategies used to improve oxygenation during HFV are similar to those used during conventional ventilation. For optimal oxygen delivery, assisted ventilation should be used with a strategy that maximizes ventilation-perfusion matching without impairing cardiac output. During HFV, lung volume is held relatively constant and the cycle of inflation and deflation associated with conventional ventilation is reduced. Conceptually, HFV allows the use of high end-expiratory pressures without requiring
Prevention of lung injury
Most investigators believe that the use of HFV in the management of neonates with respiratory failure reduces ventilator-induced lung injury. Results of animal experiments comparing HFV with the continued use of conventional ventilation strongly support this belief. In the premature baboon model of HMD, the use of HFOV reduces the occurrence of air leak, prevents the development of HMD, promotes uniform lung inflation, and improves gas exchange and lung mechanics.12, 27 In rhesus monkeys with
Hyaline membrane disease
Clinical trials comparing the use of HFV and conventional ventilation in neonates with HMD are not as encouraging as animal data (Table). The National Institutes of Health sponsored the largest (n = 673) study to date.34 The HIFI study group reported that HFOV was not effective in improving survival or reducing the incidence of bronchopulmonary dysplasia. In comparison with conventional ventilation, HFOV was associated with a small but significant increase in the occurrence of grades 3 and 4
COMPLICATIONS
Complications reported to be associated with HFV include hypotension, intraventricular hemorrhage, and necrotizing tracheobronchitis. The interaction of airway pressure with cardiac output is related to lung compliance and lung volume. The use of high airway pressure can cause overinflation of the lungs, reduce venous return, increase pulmonary vascular resistance, and reduce cardiac output.59 Animal and human studies show that, when used with a strategy that avoids lung hyperinflation, HFV
CONCLUSION
High-frequency ventilation often improves gas exchange in critically ill neonates in whom conventional ventilation has failed. However, its role in improving outcome has not been determined. In premature babies, it may reduce the occurrence of air leak syndromes and chronic lung disease; in term infants, it may reduce the need for ECMO. Research is needed to define the following: (1) disease-specific strategies that promote lung recovery and minimize lung injury, (2) the effect of HFV on
References (71)
- et al.
High frequency ventilation: issues of strategy
Clin Perinatol
(1991) - et al.
Gas trapping with high-frequency ventilation: jet versus oscillatory ventilation
J PEDIATR
(1987) - et al.
Alternative modes of ventilation in the prevention and treatment of bronchopulmonary dysplasia
Clin Perinatol
(1992) - et al.
Early randomized intervention with high-frequency jet ventilation in respiratory distress syndrome
J PEDIATR
(1990) - et al.
A multicenter randomized trial of high frequency oscillatory ventilation as compared with conventional mechanical ventilation in preterm infants with respiratory failure
Early Hum Dev
(1993) - et al.
Multicenter controlled trial comparing high-frequency jet ventilation and conventional mechanical ventilation in newborn infants with pulmonary interstitial emphysema
J PEDIATR
(1991) - et al.
Prospective, randomized comparison of high-frequency oscillation and conventional ventilation in candidates for extracorporeal membrane oxygenation
J PEDIATR
(1994) - et al.
Hidden mortality rate associated with extracorporeal membrane oxygenation
J PEDIATR
(1990) - et al.
High frequency ventilation for acute pediatric respiratory failure
Chest
(1993) - et al.
Tracheal and bronchial injury in high-frequency oscillatory ventilation compared with conventional positive pressure ventilation
J PEDIATR
(1987)
Mechanisms of ventilator-induced lung injury
Crit Care Med
Chest wall restriction limits high airway pressure-induced lung injury in young rabbits
J Appl Physiol
Role of tidal volume FRC and end-inspiratory volumes in development of pulmonary edema following mechanical ventilation
Am Rev Respir Dis
Symposium on synthetic surfactant
J PEDIATR
Management of infants with severe respiratory failure and persistence of the fetal circulation, without hyperventilation
Pediatrics
High-frequency ventilation for immature infants
Pediatrics
Decreased pulmonary barotrauma with the use of volumetric diffusive respiration in pediatric patients with burns
J Burn Care Rehabil
High-frequency ventilation in the treatment of infants weighing less than 1500 grams with pulmonary interstitial emphysema: a pilot study
Pediatrics
Pulmonary interstitial emphysema in the premature baboon with hyaline membrane disease
Crit Care Med
Effect of high-frequency ventilation on gas exchange and pulmonary vascular resistance in lambs
J Appl Physiol
Role of lung injury in the pathogenesis of hyaline membrane disease in premature baboons
J Appl Physiol
Optimizing alveolar expansion prolongs the effectiveness of exogenous surfactant therapy in the adult rabbit
Am Rev Respir Dis
A comparison of ventilation strategies for the use of high-frequency oscillatory ventilation in the treatment of hyaline membrane disease
Acta Anaesthesiol Scand
High-frequency oscillatory ventilation versus intermittent mandatory ventilation: early hemodynamic effects in the premature baboon with hyaline membrane disease
Pediatr Res
Volume recruitment maneuvers are less deleterious than persistent low lung volumes in the atelectasis-prone rabbit lung during high-frequency oscillation
Crit Care Med
Sustained inflation during HFOV improves pulmonary mechanics and oxygenation
J Appl Physiol
Effects of HFO and sustained inflations on arterial blood pressure and intracranial pressure in rabbits
Alveolar ventilation at high frequencies using tidal volumes smaller than the anatomical dead space
Lung Biol Health Dis
Mechanisms of gas transport during ventilation by high frequency oscillation
J Appl Physiol
High-frequency ventilation
Physiol Rev
Summary: pulmonary mechanics during high frequency ventilation
Acta Anaesthesiol Scand
Local gas transport in eucapnic ventilation: effects of gravity and breathing frequency
J Appl Physiol
Proximal, tracheal, and alveolar pressures during high- frequency oscillatory ventilation in a normal rabbit model
Pediatr Res
Factors influencing mechanical performance of neonatal high-frequency ventilators
J Appl Physiol
Ventilatory management of infant baboons with hyaline membrane disease: the use of high frequency ventilation
Pediatr Res
Cited by (131)
High-frequency ventilation
2022, Goldsmith's Assisted Ventilation of the Neonate: An Evidence-Based Approach to Newborn Respiratory Care, Seventh EditionPharmacologic Therapies II: Inhaled Nitric Oxide
2017, Assisted Ventilation of the Neonate: An Evidence-Based Approach to Newborn Respiratory Care: Sixth EditionCurrent methods of non-invasive ventilatory support for neonates
2011, Paediatric Respiratory ReviewsCitation Excerpt :The PCO2 was significantly lowered by nHFV, suggesting that nasal ventilation, and specifically nHFV, improved CO2 elimination. The mechanism of CO2 reduction during nHFV is complex and is not completely understood.108 Further research is needed to demonstrate the effectiveness and safety of nHFV in seriously ill patients before this expensive therapy compared to traditional cheap CPAP therapy can be recommended for widespread use.105
Neonatal Respiratory Disease
2011, Pediatric Critical Care: Expert Consult Premium EditionNeonatal Respiratory Disease
2011, Pediatric Critical CareSpecial Ventilation Techniques III: Inhaled Nitric Oxide Therapy
2011, Assisted Ventilation of the Neonate
- ☆
From the Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia
- ☆☆
Reprint requests: Reese H. Clark, MD, Department of Pediatrics, 2040 Ridgewood Dr., Atlanta, GA 30322.
- ★
0022-3476/94/$3.00 + 0 9/18/53904