High frequency oscillatory ventilation in children. What do we know so far?

Area of Science:

• Pediatric Critical Care Medicine
• Respiratory Physiology
• Mechanical Ventilation

Background:

• Pediatric respiratory failure is a common reason for ICU admission globally.
• Acute respiratory distress syndrome (ARDS) is the most severe form, with high mortality (33%).
• Current ventilator strategies for heterogeneous ARDS have limitations.

Purpose of the Study:

• To review the principles and physiology of High Frequency Oscillatory Ventilation (HFOV).
• To discuss the role of HFOV in managing pediatric respiratory failure.
• To highlight HFOV strategies like "open lung" and "low volume" ventilation.

Main Methods:

• Review of existing literature on HFOV in pediatric respiratory failure.
• Discussion of physiological principles underlying HFOV.
• Analysis of HFOV application in specific pediatric conditions.

Main Results:

• HFOV is an alternative mechanical ventilation strategy with potential to improve gas exchange.
• HFOV may help limit ventilator-induced lung injury.
• Specific strategies like "open lung" and "low volume" ventilation are discussed for different pediatric respiratory failure scenarios.

Conclusions:

• HFOV presents an alternative approach for pediatric respiratory failure management.
• The "open lung" strategy is emphasized for conditions reducing functional residual capacity.
• The "low volume" strategy is relevant for airleak syndromes like pneumothorax.