History of high frequency oscillation

The article describes the evolution of high frequency oscillation since its first use by Lunkenheimer through the initial failed NIH trial and subsequent more successful trials to its current widespread use in the neonatal population. The importance of oscillating at an optimal lung volume, achieved through a volume recruitment manoeuvre, is emphasised as is the efficacy with which oscillation clears CO2. The lack of adequate control of these two factors in the initial NIH trial is suggested as a possible cause of the trial's failure. Comment is made on optimising oscillator settings as well on elementary mechanics of high frequency oscillation and the effect of high frequency oscillation on surfactant degradation. Given the difficulty of recruiting lung volume in late RDS, a suggestion is made to combine high frequency oscillation with perfluorocarbon. The former as a mechanism for maintaining lung volume which has been recruited by the perfluorocarbon. The authors speculate that the use of high frequency oscillation will increase in both the paediatric and adult population.