Neonatal Research, Murdoch Children's Research Institute, Parkville, Victoria, Australia.
Department of Paediatrics, The University of Melbourne, Melbourne, Victoria, Australia.
Arch Dis Child Fetal Neonatal Ed. 2024 Aug 16;109(5):467-474. doi: 10.1136/archdischild-2023-325657.
High-frequency oscillatory ventilation (HFOV) is an established mode of respiratory support in the neonatal intensive care unit. Large clinical trial data is based on first intention use in preterm infants with acute respiratory distress syndrome. Clinical practice has evolved from this narrow population. HFOV is most often reserved for term and preterm infants with severe, and often complex, respiratory failure not responding to conventional modalities of respiratory support. Thus, optimal, and safe, application of HFOV requires the clinician to adapt mean airway pressure, frequency, inspiratory:expiratory ratio and tidal volume to individual patient needs based on pathophysiology, lung volume state and infant size. This narrative review summarises the status of HFOV in neonatal intensive care units today, the lessons that can be learnt from the past, how to apply HFOV in different neonatal populations and conditions and highlights potential new advances. Specifically, we provide guidance on how to apply an open lung approach to mean airway pressure, selecting the correct frequency and use of volume-targeted HFOV.
高频振荡通气（HFOV）是新生儿重症监护病房中一种成熟的呼吸支持模式。大量的临床试验数据基于急性呼吸窘迫综合征早产儿的一线应用。临床实践已经从这个狭窄的人群中发展而来。HFOV 最常用于治疗对传统呼吸支持模式无反应的严重且通常复杂的呼吸衰竭的足月和早产儿。因此，HFOV 的最佳和安全应用需要临床医生根据病理生理学、肺容积状态和婴儿大小，将平均气道压力、频率、吸气：呼气比和潮气量调整到个体患者的需求。本叙述性综述总结了目前新生儿重症监护病房中 HFOV 的现状、可以从过去吸取的经验教训、如何在不同的新生儿人群和情况下应用 HFOV 以及突出潜在的新进展。具体来说，我们提供了关于如何将开放肺方法应用于平均气道压力、选择正确的频率以及使用容量目标 HFOV 的指导。
