A reappraisal of high-frequency ventilation in the critical care setting

Current Opinion in Critical Care

Volumn 2, Issue 1, 1996, Pages 54-59

  Froese, Alison B ^a  

^a KINGSTON GENERAL HOSPITAL   (Canada)

Author keywords

[No Author keywords available]

Indexed keywords

EID: 1542631738     PISSN: 10705295     EISSN: None     Source Type: Journal    
DOI: 10.1097/00075198-199602000-00008     Document Type: Article

References (43)

1. Stewart TE, Slutsky AS: Mechanical ventilation: a shifting philosophy. Curr Opin Crit Care 1995, 1:49-56. The philosophy of ventilator support is changing. Protecting the lung from ventilator-induced lung injury is now getting priority over maintaining physiologic blood gas values. Although the best method of achieving this has not yet been established, the target is now to recruit atelectatic, consolidated lung while avoiding overdistension.
2. Slutsky AS: Mechanical ventilation. Chest 1993, 104:1833-1859.
3. McCulloch PR, Forkert PG, Froese AB: Lung volume maintenance prevents lung injury during high frequency oscillatory ventilation in surfactant-deficient rabbits. Am Rev Respir Dis 1988, 137:1185-1192.
4. Muscedere JG, Mullen JBM, Gan K, Slutsky AS: Tidal ventilation at low airway pressures can augment lung Injury. Am J Respir Crit Care Med 1994, 149:1327-1334.
5. Arnold JH, Hanson JH, Toro-Figuero LO, Gutierrez J, Berens RJ, Anglin DL. Prospective, randomized comparison of high-frequency oscillatory ventilation and conventional mechanical ventilation in pediatric respiratory failure. Crit Care Med 1994, 22:1530-1539. This is the first randomized controlled trial of HFOV in the pediatric population. HFOV was used with an aggressive volume recruitment strategy but still induced fewer complications than a conventional ventilation strategy that used increased inspiratory times and PEEP to pursue alveolar expansion while limiting peak pressures. This study is commendable for its detailed pathophysiologically based ventilator protocols and objective crossover criteria. A ranked outcome analysis indicated significantly better outcomes with HFOV.
6. Patel CA, Klein JM: Outcome of infants with birth weights less than 1000 g with respiratory distress syndrome treated with high-frequency ventilation and surfactant replacement therapy. Arch Pediatr Adolesc Med 1995, 149:317-321. This retrospective review of infants weighing under 1000 g was primarily a safety check to make sure no harm was coming to these small premature infants from the use of HFV in conjunction with surfactant. HFV proved as safe as CMV with respect to neurologic outcome even though babies treated with HFV were significantly smaller and more premature.
7. Gerstmann DR, Minton SD, Stoddard RA: Results of the Provo multicenter surfactant high frequency oscillatory ventilation controlled trial. Ped Res 1995, 37:333A.
8. Venegas JG, Fredberg JJ: Understanding the pressure cost of ventilation: why does high-frequency ventilation work? Crit Care Med 1994, 22:S49-S57. This paper is a must for matching frequency and PEEP selections during HFV to varying lung pathophysiologies. The authors take complex transport theory and turn it into a clinically useable format with minimal mathematics. The three-dimensional graphs are worth the effort needed to decipher their implications. This analysis clarifies how too little PEEP can produce barotrauma, not just too much PEEP.
9. Pedley TJ, Corieri P, Kamm RD, Grotberg JB, Hydon PE, Schroter RC: Gas flow and mixing in the airways. Crit Care Med 1994, 22(suppl 9):S24-S36. This article summarizes six approaches to the fluid dynamic mechanisms underlying gas transport during HFV. Accurate simulations are still only possible for relatively simple ideal geometries, not real lungs.
10. Sugiura M, McCulloch PR, Wren S, Dawson RH, Froese AB: Ventilator pattern influences neutrophil influx and activation in atelectasis-prone rabbit lung. J Appl Physiol 1994, 77:1355-1365. This study demonstrates that ongoing atelectasis induces the inflammatory changes characteristic of ARDS in a vulnerable lung. When repetitive alveolar and airway opening and collapse were avoided by using appropriate HFOV settings, both neutrophil activation and lung injury were prevented.
11. 2 than did conventional ventilation in surfactant-deficient rabbits. This study supports the conclusion of the paper by Sugiura et al. (J Appl Physiol 1994, 77:1355-1365) that ventilator pattern impacts significantly on the pulmonary inflammatory process. Supporting gas transport while avoiding both extremes of lung volume minimizes mediator production and release.
12. Sandhar BK, Niblett DJ, Argiras EP, Dunnill MS, Sykes MK: Effects of positive end-expiratory pressure on hyaline membrane formation in a rabbit model of the neonatal respiratory distress syndrome. Intensive Care Med 1988, 14:538-546.
13. Jackson JC, Truog WE, Standaert TA, Murphy JH, Juul SE, Chi EY, Hildebrandt J, Hodson WA: Reduction in lung injury after combined surfactant and high-frequency ventilation. Am J Respir Crit Care Med 1994, 150:534-539. This study demonstrates the value of combination therapy with surfactant plus HFOV used so as to achieve an optimal aeration pattern in the premature monkey. Although each treatment independently reduces the development of proteinaceous alveolar edema and lung injury, the best outcome occurred with the two used in combination. The gains achieved with surfactant do not render HFV superfluous. If more than minimal ventilator support is required post surfactant, HFOV will be less injurious to the lung than conventional techniques.
14. Wiswell TE, Peabody SS, Davis JM, Slayter MV, Bent RC, Merritt TA: Surfactant therapy and high-frequency jet ventilation in the management of a piglet model of the meconium aspiration syndrome. Pediatr Res 1994, 36:494-500.
15. Simon BA, Tsuzaki K, Venegas JG: Ventilation distribution and regional lung impedance during partial unilateral bronchial obstruction. J Appl Physiol 1995, 78:663-669.
16. Bysani GK, Rucoba RJ, Noah ZL: Treatment of hydrocarbon pneumonitis. High frequency jet ventilation as an alternative to extracorporeal membrane oxygenation. Chest 1994, 106:300-303.
17. Thompson MW, Bates JN, Klein JM: Treatment of respiratory failure in an infant with bronchopulmonary dysplasia infected with respiratory syncytial virus using inhaled nitric oxide and high frequency ventilation. Acta Paediatr 1995, 84:100-102.
18. Baird JS, Johnson JJ, Escudero J, Powars DR: Combined pressure control/high frequency ventilation in adult respiratory distress syndrome and sickle cell anemia. Chest 1994, 106:1913-1916.
19. Nichols DG: Taming the technology for adult respiratory distress syndrome in children. Crit Care Med 1994, 22:1521-1524. This editorial raises important questions about the optimal timing for intervention with lung-sparing techniques such as HFOV. As modalities proliferate important decisions must be addressed about which modality to use, and when to use it or move on to something else.
20. Miguet D, Claris O, Lapillonne A, Bakr A, Chappuis JP, Salle BL: Preoperative stabilization using high-frequency oscillatory ventilation in the management of congenital diaphragmatic hernia. Crit Care Med 1994, 22(suppl 9):S77-S82.
21. Al-Alaiyan S, Katan A: Pulmonary interstitial emphysema treated by selective bronchial obstruction and high-frequency oscillatory ventilation. Am J Perinatol 1994, 11:433-435.
22. Clark RH, Gerstmann DR, Null DM, deLemos RA: Prospective randomized comparison of high frequency oscillatory and conventional ventilation in respiratory distress syndrome. Pediatrics 1992, 89:5-12.
23. Ogawa Y, Miyasaka K, Kawano T, Imura S, Inukai K, Okuyama K, Oguchi K, Togari H, Nishida H, Mishina J: A multicenter randomized trial of high frequency oscillatory ventilation as compared with conventional mechanical ventilation in preterm infants with respiratory failure. Early Hum Dev 1993, 32:1-10.
24. The HIFI Study Group: High frequency oscillatory ventilation compared with conventional mechanical ventilation in the treatment of respiratory failure in preterm infants. N Engl J Med 1989, 320:88-93.
25. Bryan AC, Froese AB: Reflections on the HIFI trial. Pediatrics 1991, 87:565-567.
26. Godet G, Bertrand M, Rouby JJ, Coriat P, Hag B, Kieffer E, Viars P: High-frequency jet ventilation vs continuous positive airway pressure for differential lung ventilation in patients undergoing resection of thoracoabdominal aortic aneurysm. Acta Anaesthesiol Scand 1994, 38:562-568. Adult HFV has been rare in recent years. Although this paper describes a specific surgical application of HFJV, these authors also have extensive experience with HFJV at optimized lung volumes in adults with acute respiratory failure, which can be accessed via the reference list.
27. Nakatsuka M: Unilateral high-frequency jet ventilation during one-lung ventilation for thoracotomy: updated in 1995. Ann Thorac Surg 1995, 59:1610.
28. Brichant JF, Rouby JJ, Viars P: Intermittent positive pressure ventilation with either positive end-expiratory pressure or high frequency jet ventilation (HFJV), or HFJV alone in human acute respiratory failure. Anesth Analg 1986, 65:1135-1142.
29. Froese AB: Role of lung volume in lung injury: HFO in the atelectasisprone lung. Acta Anaesthesiol Scand 1989, 33:126-130.
30. Gerstmann DR, deLemos RA, Clark RH: High-frequency ventilation: Issues of strategy. Clin Perinatol 1991, 18:563-580.
31. HiFO Study Group: Randomized study of high-frequency oscillatory ventilation in infants with severe respiratory distress syndrome. J Pediatr 1993, 122:609-619.
32. Carlon GC, Howland WS, Ray C, Miodownik S, Griffin JP, Groeger JS: High-frequency jet ventilation: a prospective randomized evaluation. Chest 1983, 84:551-559.
33. Paranka MS, Clark RH, Yoder BA, Null DM: Predictors of failure of high-frequency oscillatory ventilation in term infants with severe respiratory failure. Pediatrics 1995, 95:400-404. This paper addresses an extremely important issue: at what point can and should one identify a patient as an HFOV nonresponder and proceed on to the next available option such as extracorporeal membrane oxygenation? Persistence of an arterial/alveolar oxygen ratio of 0.08 or lower after 6 hours of HFOV was the most sensitive and specific predictor of the ultimate need for extracorporeal membrane oxygenation in this series of 190 infants.
34. Kinsella JP, Abman SH: Recent developments in the pathophysiology and treatment of persistent pulmonary hypertension of the newborn. J Pediatr 1995, 126:853-864. This paper provides an excellent analysis of why pulmonary treatments may need to be applied in appropriate combinations. Examples are given in which HFOV was used in neonates to achieve optimal lung inflation, thereby enabling effective delivery of the inhalational vasodilator, nitric oxide.
35. Bond DM, McAloon J, Froese AB: Sustained inflations improve respiratory compliance during high-frequency oscillatory ventilation but not during large tidal volume positive-pressure ventilation in rabbits. Crit Care Med 1994, 22:1269-1277.
36. Zobel G, Dacar D, Rödl S: Hemodynamic effects of different modes of mechanical ventilation in acute cardiac and pulmonary failure: an experimental study. Crit Care Med 1994, 22:1624-1630.
37. Froese AB, McCulloch PR, Sugiura M, Vaclavik S, Possmayer F, Moller F: Optimizing alveolar expansion prolongs the effectiveness of exogenous surfactant therapy in the adult rabbit. Am Rev Respir Dis 1993, 148:569-577.
38. Nicol ME, Dritsopoulou A, Wang C, Holdcroft A, Chakrabarti MK, Whitwam JG: Ventilation techniques to minimize circulatory depression in rabbits with surfactant deficient lungs. Pediatr Pulmonol 1994, 18:317-322.
39. Cros AM, Kays C, Ravussin P, Guenard H: Is proximal airway pressure a good reflection of peripheral airspace pressure in infants and children models under HFJV? Int J Clin Monit Comput 1994, 11:171-178. This study concludes that even tracheal airway pressure monitoring will underestimate mean alveolar pressures during HFJV at rates up to 300 bpm, especially in the presence of heterogeneous lung compliances. (Note: These data are specific to HFJV, a modality with a passive expiratory phase.)
40. Zobel G, Dacar D, Rödl S: Proximal and tracheal airway pressures during different modes of mechanical ventilation: an animal model study. Pediatr Pulmonol 1994, 18:239-243. This study claims that proximal airway pressure monitoring is good enough for monitoring HFJV, in direct contradiction to the paper by Cros et al. (Int J Clin Monit Comput 1994, 11:171-178) and many earlier studies.
41. Roithmaier A, Hultzsch W, Lipowsky G, Reinhardt D: Airway pressure measurements during high-frequency positive pressure ventilation in extremely low birth weight neonates. Crit Care Med 1994, 22(suppl 9):S71-S76.
42. Chan V, Greenough A: The effect of frequency on carbon dioxide levels during high frequency oscillation. J Perinat Med 1994, 22:103-106. The principle findings of this study are well described in the manufacturer's operating manual and many previous publications.
43. Nicklaus PJ: Airway complications of jet ventilation in neonates. Ann Otol Rhinol Laryngol 1995, 104:24-30.