High-frequency ventilation in adults

INTRODUCTION

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 [1]. The indications for HFV are limited and its use should be coordinated by clinicians who have experience using HFV.

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).

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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Literature review current through: Apr 2013. | This topic last updated: Feb 7, 2013.
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