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¹Department of Anesthesia, Children's Hospital, Boston, MA 02115, USA.

Pediatric Critical Care Medicine : a Journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies

|June 19, 2003

Insights

High-frequency oscillatory ventilation (HFOV) offers an effective lung-protective strategy for pediatric respiratory failure. Early use of HFOV, particularly with an open lung approach, improves outcomes in neonates and infants.

Area of Science:

Pediatric Critical Care Medicine
Respiratory Physiology
Mechanical Ventilation

Background:

Respiratory failure is a significant cause of mortality in pediatric patients.
Conventional ventilation strategies can lead to ventilator-induced lung injury.
High-frequency oscillatory ventilation (HFOV) has emerged as an alternative approach.

Purpose of the Study:

To review the current state of high-frequency oscillatory ventilation (HFOV) in managing pediatric respiratory failure.
To explore the efficacy and application of HFOV in neonatal and pediatric populations.
To discuss disease-specific strategies and future directions for HFOV.

Main Methods:

Comprehensive literature review of preclinical and clinical studies.
Analysis of pathophysiology of respiratory failure.
Evaluation of high-frequency ventilation techniques in neonates and infants.

Main Results:

HFOV, especially with an "open lung" strategy, is a promising approach for hypoxemic respiratory failure.
Key gas exchange mechanisms include bulk axial flow, interregional gas mixing, and molecular diffusion.
Positive responses observed in infants with hyaline membrane disease and congenital diaphragmatic hernia.

Conclusions:

Early HFOV implementation may be the ideal strategy for pediatric hypoxemic respiratory failure.
The oxygenation index can predict mortality and guide therapy in HFOV patients.
Future combination of HFOV and partial liquid breathing may offer ultimate lung protection.

Read full analysis

Abstract

Objective:

To provide a state-of-the-art review of high-frequency oscillatory ventilation in the management of pediatric patients with respiratory failure.

Data Sources:

A thorough analysis of the preclinical and clinical literature regarding the pathophysiology of respiratory failure and the efficacy of high-frequency techniques in the neonatal and pediatric populations.

Data Synthesis:

After an overview of the introduction of high-frequency techniques, the following topical areas are addressed: device vs. strategy, indications for use, disease-specific strategies, additional practical considerations, and the future of high-frequency techniques.

Conclusions:

The ideal ventilatory approach in patients with hypoxemic respiratory failure may be early institution of an "open lung" strategy using high-frequency ventilatory techniques. The mechanisms of gas exchange that are most important during high-frequency ventilation are bulk axial flow, interregional gas mixing, and molecular diffusion. Infants with hyaline membrane disease and congenital diaphragmatic hernia have also responded positively to the implementation of high-frequency techniques. The oxygenation index (mean airway pressure x Fio2 x 100/Pao2) provides useful prognostic information in patients being managed with high-frequency oscillatory ventilation and may help to identify those patients with high predicted mortality to offer additional or experimental therapies. In the future, the combination of high-frequency oscillatory ventilation and partial liquid breathing offers the possibility of partitioning the physiologic changes associated with positive pressure ventilation. This approach may prove to be the ultimate lung-protective ventilatory strategy.

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