chapter  27
14 Pages

Rationale for High-Frequency Oscillatory Ventilation in Acute Lung Injury

WithJeffrey M. Singh, Niall D. Ferguson, Thomas E. Stewart

Since its advent in the early 1950s, positive pressure mechanical ventilation

has become instrumental in the support of the critically ill patient. In recent years, there has been a greater understanding of the pathogenesis of acute

lung injury, and it is now clear that mechanical ventilation can potentiate or

cause further lung damage. This evolving understanding has spurred the

search for ventilation strategies that mitigate ventilator-induced lung injury

(VILI). The principles of lung protection have been applied by using con-

ventional mechanical ventilation (CMV) with demonstrable clinical benefit,

but this does not necessarily imply that further reduction of VILI is not

attainable using other methods. First described in 1972 (1), high-frequency oscillatory ventilation

(HFOV) is a form of high-frequency ventilation that has the potential to

accomplish many of the goals of lung-protective ventilation: limiting lung

overdistention and preventing cyclic lung collapse by maintaining end-

expiratory lung volume. The past decade has seen significant advances in

both the theory and understanding of HFOV as well as its clinical use in the

ventilation of the severely injured lungs of adults. This article sets out to review the rationale for and the clinical experience with HFOV, especially

in the context of adults with acute lung injury.