High Frequency Oscillatory Ventilation (HFOV)

• Although traditionally used in neonates, HFOV is becoming increasingly popular for select adult patients with ALI/ARDS.
• Benefits of HFOV include:
  • use of smaller tidal volumes than conventional ventilation
  • maintains alveoli open at a relatively constant airway pressure thereby preventing atelectrauma
  • improves ventilation/perfusion
• Indications for use of HFOV are when:
  • conventional ventilator settings require an F_iO₂ > 70% and PEEP > 14 cm H₂O OR
  • pH < 7.25 despite higher tidal volumes and plateau pressures > 30 cm H₂O
• Key variables, along with suggested initial settings, for HFOV include:
  • Frequency: 4 - 7 Hertz
  • Amplitude: 70 - 90 cm H₂O
  • Mean airway pressure: 5 cm H₂O greater than last plateau pressure measured on conventional setting
  • Bias flow: 40 L/min
  • Inspiratory time: 33%
  • F_iO₂: 100%

References

Stawicki SP, Goyal M, Sarani B. High frequency oscillatory ventilation and airway pressure release ventilation: a practical guide. Journal of Intensive Care Medicine 2009:24(4):215-229.