High-Frequency Oscillatory Ventilation for ARDS?

• High-frequency oscillatory ventilation (HFOV) is increasingly utilized for adult patients with ARDS who remain hypoxemic despite optimal settings of conventional mechanical ventilation (CMV).
• HFOV maintains a constant mean airway pressure and delivers very small tidal volumes (1-3 ml/kg) at very high respiratory rates (frequency range up to 10 Hz).
• Potential advantages to HFOV over CMV include greater alveolar recruitment, prevention of atelectrauma, and limiting excess alveolar distension (i.e. volutrauma).
• Studies on HFOV in adults are not as numerous as those in neonates.  As a result, optimal timing for initiation of HFOV is unclear.
• Nevertheless, some recommend considering HFOV for patients who persistently need an F_iO₂ > 60% with at least 10 cm H₂O of PEEP on CMV.
• Due to the ventilator settings, patients receiving HFOV often require significant sedation and often neuromuscular blockade.  

References

Ip T, Mehta S. The role of high-frequency oscillatory ventilation in the treatment of acute respiratory failure in adults. Curr Opin Crit Care 2012; 18:70-9.