High Frequency Oscillatory Ventilation (HFOV) in Pediatrics

Abstract

Conventional ventilation is not without its own set of hazards for the lungs. The concept of ventilator induced lung injury (VILI) was defined in the 1960s and modes of ventilation which were likely to be less injurious to the lung were explored. HFOV is one such modality. In high frequency ventilation, as the term states, the lungs are ventilated at very high frequencies (rates) with the aim to provide adequate minute ventilation through small volumes at high rates. The main clinical conditions in which HFOV has demonstrated benefits are situations in which there is refractory hypoxemia as in severe adult respiratory distress syndrome (ARDS) and those in which very high pressures are required for ventilation in lungs having air leaks as in patients with pneumothoraces or bronchopleural fistulae. Settings for this form of ventilation are different from those for conventional ventilation (CV). Improvement in oxygenation is early, consistent and sustained with HFOV. The most pertinent decision remains as to whether it should be initiated or not, and, that whether it may actually be beneficial to use it as an initial mode of ventilation. More studies are needed to give clear guidelines or protocols. The basics of HFOV have been reviewed, where it helps, how it works, the initiation, management, weaning advocated, and, the likely complications.