High-frequency ventilation in adults
- Anthony J Courey, MD
Anthony J Courey, MD
- Assistant Professor, Pulmonary and Critical Care
- University of Michigan Medical Center
- Robert C Hyzy, MD
Robert C Hyzy, MD
- Professor of Medicine
- University of Michigan Medical Center
High-frequency ventilation (HFV) is a form of mechanical ventilation that combines very high respiratory rates (>60 breaths per minute) with tidal volumes that are smaller than the volume of anatomic dead space . HFV is not a first-line mode of mechanical ventilation and is used rarely; its use should be coordinated by experienced clinicians only.
This topic review describes the different types of HFV, as well as patient selection, efficacy, and potential harms. Alternative modes of mechanical ventilation are described separately. (See "Modes of mechanical ventilation".)
TYPES OF HFV
There are four basic types of HFV: high frequency jet ventilation, high frequency oscillatory ventilation, high frequency percussive ventilation, and high frequency positive pressure ventilation (figure 1). Among these high frequency oscillatory ventilation is the mode that is used most often. None of these modes are first line for the management of acute respiratory distress syndrome. (See 'Patient selection' below and 'Efficacy' below.)
High frequency jet ventilation — High frequency jet ventilation (HFJV) refers to HFV delivered using a jet of gas (figure 1). It is initiated by inserting into the lumen of the endotracheal tube a small (14 to 16 gauge) cannula, which is connected to a specialized ventilator. An initial pressure of approximately 35 pounds per square inch (psi) drives the jet of gas from the cannula with an initial respiratory rate of 100 to 150 breaths per minute and an inspiratory fraction less than 40 percent (algorithm 1). The inspiratory fraction is the inspiratory time divided by the sum of the inspiratory and expiratory times. Applied positive end-expiratory pressure (PEEP) can be added if needed.
An arterial blood gas should be measured approximately 15 minutes after the initiation of HFJV:
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- TYPES OF HFV
- High frequency jet ventilation
- High frequency oscillatory ventilation
- High frequency percussive ventilation
- High frequency positive pressure ventilation
- PATIENT SELECTION
- HF jet ventilation
- HF oscillatory ventilation
- HF percussive ventilation
- SUMMARY AND RECOMMENDATIONS