What is the role of high-frequency ventilation (jet or oscillatory) for the treatment of acute respiratory distress syndrome (ARDS)?

Updated: Mar 27, 2020
  • Author: Eloise M Harman, MD; Chief Editor: Michael R Pinsky, MD, CM, Dr(HC), FCCP, FAPS, MCCM  more...
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High-frequency ventilation (jet or oscillatory) is a ventilator mode that uses low tidal volumes (approximately 1-2 mL/kg) and high respiratory rates (3-15 breaths per second). Given that distention of alveoli is known to one of the mechanisms promoting ventilator-associated lung injury, high-frequency ventilation would be expected to be beneficial in ARDS. Results of clinical trials comparing this approach with conventional ventilation in adults have generally demonstrated early improvement in oxygenation but no improvement in survival.

The largest randomized controlled trial included 548 adults with moderate-to-severe ARDS who were randomized to conventional ventilation or high-frequency oscillatory ventilation (HFOV). This study was terminated early for harm due to an in-hospital mortality rate of 47% in patients receiving HFOV and 35% in the conventional arm. [46] Therefore, HFOV is not recommended as a treatment strategy for ARDS.

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