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Acute Respiratory Distress Syndrome pp 41–60Cite as

Ventilation Strategies: High-Frequency Oscillatory Ventilation

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Abstract

High-frequency oscillatory ventilation (HFOV) comprises superimposition of pressure oscillations on a continuous positive airway pressure, termed mean airway pressure. Administered tidal volumes (usual range, 40–210 mL) depend on oscillation frequency (usual range, 3.5–10 Hz) and oscillatory pressure amplitude. Theoretically, HFOV is ideal for lung protection in the acute respiratory distress syndrome (ARDS), as it may minimize the risk of volutrauma and atelectrauma. Prior laboratory studies and the pooled results of prior, small randomized controlled trials (RCTs) of HFOV vs. conventional ventilation (CV) in ARDS were suggestive of an HFOV-associated mortality benefit. However, this hypothesis was refuted by the results of two recent large RCTs of HFOV vs. lung-protective CV. The one RCT reported no difference in mortality between treatment arms, whereas the other RCT reported an HFOV-associated harm. The latter result could be partly due to HFOV-induced dysfunction of the right ventricle (RV). In the present chapter, we provide a brief summary of the mechanisms of gas exchange during HFOV and then review published physiological and RCT data, in order to provide a rationale for selecting HFOV settings so as to achieve both lung and RV protection. In this context, we also review available data on the combination of HFOV with tracheal gas insufflation (TGI) and attempt to establish a background for future clinical research involving lung and RV protective HFOV with or without TGI. Future research could also evaluate combination treatments such as prone, lung-protective CV interspersed with supine HFOV.

The contributions of the authors George Karlis and Ioannis N. Pantazopoulos should be considered as equally important.

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Authors and Affiliations

  1. First Department of Intensive Care Medicine, University of Athens Medical School, Evaggelismos General Hospital, 45-47 Ipsilandou Street, GR, 10676, Athens, Greece

    Spyros D. Mentzelopoulos MD, PhD, George Karlis MD, PhD, Ioannis N. Pantazopoulos MD, PhD & Charikleia Vrettou MD, PhD

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  1. Spyros D. Mentzelopoulos MD, PhD
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  2. George Karlis MD, PhD
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  3. Ioannis N. Pantazopoulos MD, PhD
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  4. Charikleia Vrettou MD, PhD
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Correspondence to Spyros D. Mentzelopoulos MD, PhD .

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  1. Department of "Scienze della Salute", University of Milan, Director of Anaesthesia and Intensive Care Services , ASST Santi Paolo e Carlo, Milan, Italy

    Davide Chiumello

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Mentzelopoulos, S.D., Karlis, G., Pantazopoulos, I.N., Vrettou, C. (2017). Ventilation Strategies: High-Frequency Oscillatory Ventilation. In: Chiumello, D. (eds) Acute Respiratory Distress Syndrome. Springer, Cham. https://doi.org/10.1007/978-3-319-41852-0_4

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  • DOI: https://doi.org/10.1007/978-3-319-41852-0_4

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