High frequency oscillatory ventilation in children: an overview

The last 30 years, high frequency ventilation (HFV) has found its way from the neonatal to the paediatric and adult ICU. With its small tidal volumes, strict intrathoracic pressure variations and disengagement of ventilation from oxygenation, HFV fits in our insights nowadays in lung protective ventilation. This review provides you with an understanding of the different modes of HFV, gas exchange mechanisms during HFV which uses tidal volumes below dead space volume, and some information on nursing and weaning a child on HFV. Focus will be on the clinical use of high frequency oscillatory ventilation with a practical overview of the strategies used: the high-volume strategy designed to rapidly recruit and maintain optimal lung volume in diffuse alveolar disease and lung haemorrhage, the low volume strategy in airleak, and the open airway strategy in small airway disease where the continuous distending pressure is used to recruit and stent the airways.