High-frequency percussive ventilation in acute respiratory failure.

Area of Science:

• Critical Care Medicine
• Respiratory Physiology
• Pulmonary Medicine

Background:

• Acute Respiratory Failure (ARF) presents significant challenges in patient management.
• High-Frequency Percussive Ventilation (HFPV) is an advanced ventilation strategy.
• Understanding HFPV's efficacy in ARF is crucial for optimizing patient care.

Purpose of the Study:

• To systematically review the impact of HFPV on gas exchange and clinical outcomes in ARF patients.
• To compare HFPV with other ventilation modes, including invasive mechanical ventilation (iMV).
• To assess HFPV's safety and effectiveness during spontaneous breathing, noninvasive ventilation (NIV), and iMV.

Main Methods:

• Systematic review of randomized and non-randomized studies up to August 2023.
• Inclusion criteria: adult ARF patients, HFPV use, comparison with other modes, and relevant outcomes.
• Pooled data analysis focused on gas exchange, pulmonary infection, and mortality in HFPV versus iMV.

Main Results:

• HFPV demonstrated safe and effective application in ARF patients on spontaneous breathing or NIV, improving oxygenation.
• In iMV patients, HFPV significantly improved oxygenation and CO2 clearance, reduced pulmonary infections, and enhanced survival.
• No increased barotrauma or adverse hemodynamic effects were observed; HFPV also benefited patients on ECMO.

Conclusions:

• HFPV shows favorable physiological and clinical effects in ARF patients.
• Evidence quality is currently weak, highlighting the need for robust randomized controlled trials.
• Further research is essential to definitively establish HFPV's role in ARF management.