Neonatal high-frequency oscillatory ventilation: where are we now?

Area of Science:

• Neonatal Medicine
• Pediatric Critical Care
• Respiratory Physiology

Background:

• High-frequency oscillatory ventilation (HFOV) is a key respiratory support modality in neonatal intensive care units (NICUs).
• Initial clinical trials focused on HFOV as a first-line treatment for preterm infants with acute respiratory distress syndrome (ARDS).
• Current practice has expanded HFOV's application beyond this initial population.

Purpose of the Study:

• To review the current status and evolving clinical practice of HFOV in neonatal care.
• To provide guidance on optimizing HFOV application in diverse neonatal populations and conditions.
• To highlight potential advancements and best practices for safe and effective HFOV use.

Main Methods:

• This is a narrative review synthesizing current literature and clinical experience.
• The review focuses on adapting HFOV parameters (mean airway pressure, frequency, I:E ratio, tidal volume) to individual patient needs.
• Guidance is provided on implementing an open lung approach and utilizing volume-targeted HFOV.

Main Results:

• HFOV is now frequently reserved for term and preterm infants with severe, complex respiratory failure unresponsive to conventional therapies.
• Optimal HFOV application necessitates individualized adjustments based on pathophysiology, lung volume, and infant size.
• Specific strategies for setting mean airway pressure, frequency, and employing volume-targeted HFOV are discussed.

Conclusions:

• Clinical practice has broadened the use of HFOV beyond its initial indication in preterm infants with ARDS.
• Effective HFOV management requires a personalized approach, adapting key ventilator settings to patient-specific factors.
• This review offers practical insights for clinicians to optimize HFOV delivery and explore new advancements in neonatal respiratory support.