ABSTRACT
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.
