Low-compression high frequency positive pressure ventilation (HFPPV): a review

HFPPV is not a jet technique, as it works without air entrainment. A low-compression ventilator, with a conventional rate of 20/min, provides efficient intrapulmonary gas mixing; however, with higher rates of 60-100/min the high inspiratory flow improves transfer/mixing of gas in the conducting airways. HFPPV for endoscopy is now established in clinical practice, and its use for treatment of bronchopleural fistulas in documented. In acute respiratory failure, volume-controlled HFPPV seems to be as efficient and as well accepted by the patients as conventional intermittent positive pressure ventilation. It is important to note that enhanced gas mixing and improved gas distribution during HFPPV in acute respiratory failure patients are accomplished with lower mean airway pressure, thereby reducing barotrauma. In the future, versatile low-compression ventilators for volume-controlled IPPV and HFPPV will hopefully improve safety, efficiency and patient acceptance of mechanical ventilation in acute respiratory failure.