Meyers Morgan, Rodrigues Nathan, Ari Arzu
Methodist Children's Hospital, San Antonio, TX, USA.
Department of Respiratory Care, Texas State University, Round Rock, TX, USA.
Can J Respir Ther. 2019 May 2;55:40-46. doi: 10.29390/cjrt-2019-004. eCollection 2019.
High-frequency oscillatory ventilation (HFOV) is a lung-protective strategy that can be utilized in the full spectrum of patient populations ranging from neonatal to adults with acute lung injury. HFOV is often utilized as a rescue strategy when conventional mechanical ventilation (CV) has failed. HFOV uses low tidal volumes and constant mean airway pressures in conjunction with high respiratory rates to provide beneficial effects on oxygenation and ventilation, while eliminating the traumatic "inflate-deflate" cycle imposed by CV. Although statistical evidence supporting HFOV is particularly low, potential benefits for its application in many clinical manifestations still remain. High-frequency oscillation is a safe and effective rescue mode of ventilation for the treatment of acute respiratory distress syndrome (ARDS). All patients who have ventilator-induced lung injury (VILI) or are at risk of developing VILI or ARDS would be suitable candidates for HFOV, especially those who have failed conventional mechanical ventilation. This narrative aims to provide a review of HFOV vis-à-vis its indications, contraindications, hazards, parameters to monitoring, patient selection, clinical goals, mechanisms of action, controls for optimizing ventilation and oxygenation, clinical application in ARDS, and a comparison with other modes of mechanical ventilation.
高频振荡通气（HFOV）是一种肺保护策略，可用于从新生儿到急性肺损伤成人的全谱患者群体。当传统机械通气（CV）失败时，HFOV常被用作挽救策略。HFOV使用低潮气量和恒定的平均气道压力，结合高呼吸频率，以对氧合和通气产生有益影响，同时消除CV所施加的创伤性“充气-放气”循环。尽管支持HFOV的统计证据特别少，但其在许多临床表现中的应用仍有潜在益处。高频振荡是治疗急性呼吸窘迫综合征（ARDS）的一种安全有效的挽救性通气模式。所有患有呼吸机诱导性肺损伤（VILI）或有发生VILI或ARDS风险的患者都将是HFOV的合适候选者，尤其是那些传统机械通气失败的患者。本叙述旨在对HFOV的适应症、禁忌症、风险、监测参数、患者选择、临床目标、作用机制、优化通气和氧合的控制、在ARDS中的临床应用以及与其他机械通气模式的比较进行综述。
