High-frequency oscillatory ventilation: still a role?
OBJECTIVE
In light of emerging data from clinical trials, the place of high-frequency oscillatory ventilation (HFOV) in the management of acute respiratory distress syndrome (ARDS) is uncertain. This review provides an overview of these new clinical data and also explores new areas of investigation for HFOV in adults.


RESULTS
While prior meta-analyses suggested benefit for HFOV, updated systematic reviews published this year, which include two large recent clinical trials, now show no statistically significant impact of HFOV on mortality in adults with ARDS. It is possible that HFOV would be safer and more effective with a more individualized approach to setting mean airway pressure (mPaw). Possible techniques to achieve this include titrating mPaw in response to oxygenation or hemodynamic changes after HFOV initiation, by measuring respiratory system impedance, or by following echocardiographic changes.


CONCLUSIONS
Although not first-line, HFOV remains a tool in the armamentarium of the intensivist managing the patient with severe ARDS and refractory hypoxemia. A refinement in the approach to delivering HFOV is warranted, with more attention paid to its adverse hemodynamic consequences.
Interdepartmental Division of Critical Care Medicine, Departments of Medicine and Physiology, University of Toronto; and University Health Network and Sinai Health System.
Jensen
J
Ng
Niall D
ND
Ferguson
D006439:Hemodynamics; D006612:High-Frequency Ventilation; D006801:Humans; D045169:Severe Acute Respiratory Syndrome / Q000628:therapy*; D016896:Treatment Outcome