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:
- Standiford TJ, Morganroth ML. High-frequency ventilation. Chest 1989; 96:1380.
- Gluck E, Heard S, Patel C, et al. Use of ultrahigh frequency ventilation in patients with ARDS. A preliminary report. Chest 1993; 103:1413.
- Fessler HE, Derdak S, Ferguson ND, et al. A protocol for high-frequency oscillatory ventilation in adults: results from a roundtable discussion. Crit Care Med 2007; 35:1649.
- Hager DN, Fessler HE, Kaczka DW, et al. Tidal volume delivery during high-frequency oscillatory ventilation in adults with acute respiratory distress syndrome. Crit Care Med 2007; 35:1522.
- Fessler HE, Hager DN, Brower RG. Feasibility of very high-frequency ventilation in adults with acute respiratory distress syndrome. Crit Care Med 2008; 36:1043.
- Mentzelopoulos SD, Malachias S, Kokkoris S, et al. Comparison of high-frequency oscillation and tracheal gas insufflation versus standard high-frequency oscillation at two levels of tracheal pressure. Intensive Care Med 2010; 36:810.
- Pellicano A, Tingay DG, Mills JF, et al. Comparison of four methods of lung volume recruitment during high frequency oscillatory ventilation. Intensive Care Med 2009; 35:1990.
- Salim A, Martin M. High-frequency percussive ventilation. Crit Care Med 2005; 33:S241.
- Carlon GC, Ray C Jr, Klain M, McCormack PM. High-frequency positive-pressure ventilation in management of a patient with bronchopleural fistula. Anesthesiology 1980; 52:160.
- Bishop MJ, Benson MS, Sato P, Pierson DJ. Comparison of high-frequency jet ventilation with conventional mechanical ventilation for bronchopleural fistula. Anesth Analg 1987; 66:833.
- Eastman A, Holland D, Higgins J, et al. High-frequency percussive ventilation improves oxygenation in trauma patients with acute respiratory distress syndrome: a retrospective review. Am J Surg 2006; 192:191.
- Mehta S, Granton J, MacDonald RJ, et al. High-frequency oscillatory ventilation in adults: the Toronto experience. Chest 2004; 126:518.
- David M, Weiler N, Heinrichs W, et al. High-frequency oscillatory ventilation in adult acute respiratory distress syndrome. Intensive Care Med 2003; 29:1656.
- Ross-Anderson DJ, Ferguson C, Patel A. Transtracheal jet ventilation in 50 patients with severe airway compromise and stridor. Br J Anaesth 2011; 106:140.
- Carlon GC, Howland WS, Ray C, et al. High-frequency jet ventilation. A prospective randomized evaluation. Chest 1983; 84:551.
- Derdak S, Mehta S, Stewart TE, et al. High-frequency oscillatory ventilation for acute respiratory distress syndrome in adults: a randomized, controlled trial. Am J Respir Crit Care Med 2002; 166:801.
- Bollen CW, van Well GT, Sherry T, et al. High frequency oscillatory ventilation compared with conventional mechanical ventilation in adult respiratory distress syndrome: a randomized controlled trial [ISRCTN24242669]. Crit Care 2005; 9:R430.
- Mentzelopoulos SD, Roussos C, Koutsoukou A, et al. Acute effects of combined high-frequency oscillation and tracheal gas insufflation in severe acute respiratory distress syndrome. Crit Care Med 2007; 35:1500.
- Sud S, Sud M, Friedrich JO, et al. High frequency oscillation in patients with acute lung injury and acute respiratory distress syndrome (ARDS): systematic review and meta-analysis. BMJ 2010; 340:c2327.
- Adhikari NK, Bashir A, Lamontagne F, et al. High-frequency oscillation in adults: a utilization review. Crit Care Med 2011; 39:2631.
- Maitra S, Bhattacharjee S, Khanna P, Baidya DK. High-frequency ventilation does not provide mortality benefit in comparison with conventional lung-protective ventilation in acute respiratory distress syndrome: a meta-analysis of the randomized controlled trials. Anesthesiology 2015; 122:841.
- Meade MO, Young D, Hanna S, et al. Severity of Hypoxemia and Effect of High Frequency Oscillatory Ventilation in ARDS. Am J Respir Crit Care Med 2017.
- Fan E, Del Sorbo L, Goligher EC, et al. An Official American Thoracic Society/European Society of Intensive Care Medicine/Society of Critical Care Medicine Clinical Practice Guideline: Mechanical Ventilation in Adult Patients with Acute Respiratory Distress Syndrome. Am J Respir Crit Care Med 2017; 195:1253.
- Sud S, Sud M, Friedrich JO, et al. High-frequency oscillatory ventilation versus conventional ventilation for acute respiratory distress syndrome. Cochrane Database Syst Rev 2016; 4:CD004085.
- Ferguson ND, Cook DJ, Guyatt GH, et al. High-frequency oscillation in early acute respiratory distress syndrome. N Engl J Med 2013; 368:795.
- Young D, Lamb SE, Shah S, et al. High-frequency oscillation for acute respiratory distress syndrome. N Engl J Med 2013; 368:806.
- Sud S, Sud M, Friedrich JO, et al. High-frequency ventilation versus conventional ventilation for treatment of acute lung injury and acute respiratory distress syndrome. Cochrane Database Syst Rev 2013; :CD004085.
- Mehta S, MacDonald R, Hallett DC, et al. Acute oxygenation response to inhaled nitric oxide when combined with high-frequency oscillatory ventilation in adults with acute respiratory distress syndrome. Crit Care Med 2003; 31:383.
- Bollen CW, Uiterwaal CS, van Vught AJ. Systematic review of determinants of mortality in high frequency oscillatory ventilation in acute respiratory distress syndrome. Crit Care 2006; 10:R34.
- Ferguson ND, Chiche JD, Kacmarek RM, et al. Combining high-frequency oscillatory ventilation and recruitment maneuvers in adults with early acute respiratory distress syndrome: the Treatment with Oscillation and an Open Lung Strategy (TOOLS) Trial pilot study. Crit Care Med 2005; 33:479.
- Demory D, Michelet P, Arnal JM, et al. High-frequency oscillatory ventilation following prone positioning prevents a further impairment in oxygenation. Crit Care Med 2007; 35:106.
- Reper P, Wibaux O, Van Laeke P, et al. High frequency percussive ventilation and conventional ventilation after smoke inhalation: a randomised study. Burns 2002; 28:503.
- Hurst JM, Branson RD, DeHaven CB. The role of high-frequency ventilation in post-traumatic respiratory insufficiency. J Trauma 1987; 27:236.
- Chung KK, Wolf SE, Renz EM, et al. High-frequency percussive ventilation and low tidal volume ventilation in burns: a randomized controlled trial. Crit Care Med 2010; 38:1970.
- Angus DC, Lidsky NM, Dotterweich LM, Pinsky MR. The influence of high-frequency jet ventilation with varying cardiac-cycle specific synchronization on cardiac output in ARDS. Chest 1997; 112:1600.
- 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