Fessler Henry E, Hess Dean R
Pulmonary and Critical Care Medicine, Johns Hopkins School of Medicine, 1830 Monument Street, Baltimore, MD 21287, USA.
Respir Care. 2007 May;52(5):595-605; discussion 606-8.
High-frequency ventilation is the application of mechanical ventilation with a respiratory rate > 100 breaths/min. High-frequency oscillatory ventilation (HFOV) is the form of high-frequency ventilation most widely used in adult critical care. The principles of lung-protective ventilation have matured in parallel with the technology for HFOV. The 2 basic principles of lung-protective ventilation are the use of small tidal volume and maintenance of adequate alveolar recruitment. Research in animal models and humans demonstrate that HFOV can support gas exchange with much smaller tidal volume than can be achieved with conventional ventilation. HFOV also provides more effective lung recruitment than conventional mechanical ventilation. However, at present, evidence is lacking that survival in adults with acute respiratory distress syndrome is improved by HFOV. Although HFOV may improve P(aO(2)) in some patients, this improvement is often transitory. Available evidence does not support that pulmonary inflammation is reduced with HFOV in adult acute respiratory distress syndrome. Heavy sedation and often paralysis are necessary. The promise of HFOV as a lung-protective ventilation strategy remains attractive, but additional clinical trials are needed to determine whether this approach is superior to lung-protective ventilation with conventional mechanical ventilation.
高频通气是指应用呼吸频率>100次/分钟的机械通气。高频振荡通气（HFOV）是成人重症监护中应用最广泛的高频通气形式。肺保护性通气的原则与HFOV技术同步成熟。肺保护性通气的2个基本原则是使用小潮气量和维持足够的肺泡复张。动物模型和人体研究表明，与传统通气相比，HFOV能够以更小的潮气量支持气体交换。HFOV也比传统机械通气能更有效地实现肺复张。然而，目前缺乏证据表明HFOV能改善急性呼吸窘迫综合征成人患者的生存率。尽管HFOV可能会改善部分患者的动脉血氧分压（P(aO₂)），但这种改善往往是短暂的。现有证据不支持HFOV能减轻成人急性呼吸窘迫综合征患者的肺部炎症。通常需要深度镇静并常常辅以肌松。HFOV作为一种肺保护性通气策略的前景依然诱人，但还需要更多临床试验来确定这种方法是否优于传统机械通气的肺保护性通气。
