%0 Journal Article
%T ICU Cornerstone: High frequency ventilation is here to stay
%A Peter C Rimensberger
%J Critical Care
%D 2003
%I BioMed Central
%R 10.1186/cc2327
%X As medical students we were told that mechanical ventilation needs convective gas flow. As residents we learned then that we must normalize gas exchange during mechanical ventilation. We also learned, based on the Radford nomogram published in 1954 [1], that there are some 'normal' respiratory rates and some 'normal' tidal volumes that may be employed to mimic normal physiology.However, as Henderson and coworkers [2] concluded from their observations in panting dogs almost 90 years ago, adequate alveolar ventilation can be achieved at high respiratory rates and very small tidal volumes at about or below the dead space volume. This could be accomplished using either conventional ventilation at low tidal volumes (3¨C4 ml/kg) and high rates (above 60/min), with an additional high flow of fresh gas delivered to the patient by a side connector connected to the endotracheal tube (high-frequency positive pressure ventilation), a high-velocity gas jet through a small catheter (high-frequency jet ventilation [HFJV]), a sliding venturi (high-frequency percussive ventilation), or a piston driven oscillator (high-frequency oscillation [HFO]).Although all of these alternative methods to achieve conventional ventilation are highly effective in eliminating carbon dioxide using low peak airway pressures, the effect on oxygenation is less uniform, and this represents one reason why these newer modes of ventilation (especially HFO) failed to maintain their initial attraction during the subsequent years. Another reason was the publication of the first large multicentre trial (the HiFi trial) in 1989, completed before surfactant became available, that failed to demonstrate better outcomes with HFO than with conventional ventilation in the treatment of respiratory failure in preterm infants [3]. The data from HiFi and a subsequent trial with HFJV [4] indicated an increase in adverse cerebral outcomes in infants assigned to the high-frequency arm. This became another major and persistent
%K acute lung injury (respiratory distress syndrome
%K adult)
%K high-frequency ventilation
%K hypercapnia
%K respiratory distress syndrome (infant)
%K respiratory physiology.
%U http://ccforum.com/content/7/5/342