High-frequency oscillatory ventilation for acute respiratory distress syndrome in adult patients

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Abstract
High-frequency oscillatory ventilation (HFOV) using an open-lung strategy has been demonstrated to improve oxygenation in neonatal and pediatric respiratory failure, without increasing barotrauma. Animal studies using small (7 days). A recently published randomized, controlled trial in acute respiratory distress syndrome patients (n = 148) comparing HFOV with a pressure-control ventilation strategy (Pao(2)/Fio(2) ratio of 10 cm H(2)O) demonstrated early (15 cm H(2)O). It is currently unknown whether initiating HFOV at a lower severity threshold would result in reduced ventilator-associated lung injury or mortality. Future studies should compare different algorithms of applying HFOV to determine the optimal techniques for achieving oxygenation and ventilation, while minimizing ventilator-associated lung injury. The potential role of adjunctive therapies used with HFOV (e.g., prone ventilation, inhaled nitric oxide, aerosolized vasodilators, liquid ventilation) will require further research.

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