Chest
Volume 118, Issue 3, September 2000, Pages 795-807
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Critical Care Reviews
High-Frequency Ventilation for Acute Lung Injury and ARDS

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In patients with acute lung injury (ALI) and ARDS,conventional mechanical ventilation (CV) may cause additional lunginjury from overdistention of the lung during inspiration, repeatedopening and closing of small bronchioles and alveoli, or from excessivestress at the margins between aerated and atelectatic lung regions. Increasing evidence suggests that smaller tidal volumes(Vts) and higher end-expiratory lung volumes (EELVs) may beprotective from these forms of ventilator-associated lung injury and may improve outcomes from ALI/ARDS. High-frequency ventilation(HFV)-based ventilatory strategies offer two potential advantages over, CV for pateints with ALI/ARDS. First, HFV uses very small, Vts, allowing higher EELVs with less overdistention than ispossible with CV. Second, despite the small Vts, highrespiratory rates during HFV allow the maintenance of normal ornear-normal Paco2 levels. In this review, theuse of HFV as a lung protective strategy for patients with ALI/ARDS isdiscussed.

Key words

acute lung injury
ARDS
barotrauma
high-frequency ventilation
high-frequency positive-pressure ventilation
high-frequency jet ventilation
high-frequency oscillation
mechanical ventilation
volutrauma

Abbreviations

ALI
acute lung injury
APACHE
acute physiology and chronic health evaluation
CV
conventional mechanical ventilation
EELV
end-expiratorylung volume
EILV
end-inspiratory lung volume;f = respiratory rate
Fio2
fraction of inspired oxygen
HFJV
high-frequency jet ventilation
HFO
high-frequencyoscillation
HFO-Hi
high-frequency oscillation with highend-expiratory lung volume
HFO-Lo
high-frequency oscillation withlow end-expiratory lung volume
HFPPV
high-frequencypositive-pressure ventilation
HFPV
high-frequency percussiveventilation
HFV
high-frequency ventilation
I/E
inspiratory/expiratory
MAP
mean airway pressure
NHLBI
National Heart, Lung, and Blood Institute
NIH
National, Institutes of Health
PEEP
positive end-expiratory pressure
Pflex
midpoint of the portion of the pressure-volumecurve with increasing slope
PIE
pulmonary interstitial emphysema
RDS
respiratory distress syndrome
UHFV
ultra high-frequencyventilation
VALI
ventilator-associated lung injury
Vt
tidal volume

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The authors have no financial interest in the subject discussed in thisarticle.