High-frequency oscillatory ventilation in infants and children

The goal of mechanical ventilation in patients with acute lung injury is to support gas exchange and mitigate ventilator-associated lung injury. High-frequency oscillatory ventilation relies on the generation of a constant distending pressure, small tidal volumes and rapid respiratory rates with the intent to recruit atelectatic lung, reduce peak inflating pressures and limit volutrauma. The utilization of high-frequency oscillatory ventilation has dramatically increased in neonatal and pediatric intensive care units. As there is an overlap between the intensive care unit and the operating room, anesthesiologists must be familiar with recent advances in the care of infants and children with acute respiratory failure. High-frequency oscillatory ventilation has been used successfully to manage patients with severe respiratory failure who have failed conventional mechanical ventilation. When initiated early, high-frequency oscillatory ventilation has been shown to improve oxygenation and reduce acute and chronic lung injury in neonates, infants and children. Further trials are necessary to better delineate the benefits and risks of this therapy in various patient populations.