[Ventilation at high-frequency oscillation: towards diminished barotrauma in the ventilated newborn?]

Mechanical ventilation is one of the fundamentals of intensive care assuring the correction of blood gas anomalies in patients with respiratory distress. However, positive pressure ventilation is extremely deleterious for the lung due to barotrauma. Among avenues of research over the last twenty years is a technique which has been successfully developed in neonatal intensive care: ventilation by high frequency oscillation (VOHF). Experimental studies have shown a net benefit in terms of oxygenation and diminution of barotrauma. A unique feature of this mechanical ventilation technique is that the clinical studies comparing VOHF to conventional ventilation have shown that for certain individuals there is decreased morbidity, notably in the incidence of bronchopulmonary dysplasia. In a paradoxical manner VOHF assures adequate gas exchange by using tidal volumes which are lower than the anatomical dead space. The usual model for alveolar ventilation is unable to explain how gas exchange is possible with this mode of ventilation. The explanations are still incomplete but this new type of artificial ventilation is in line with current studies by physiologists whose research may explain this totally new type of pulmonary physiology. However, it should be used cautiously and reserved to those practitioners experienced in the technique.