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NeoReviews Vol.7 No.5 2006 e234
© 2006 American Academy of Pediatrics

High-frequency Ventilation: Evidence-based Practice and Specific Clinical Indications

^* Professor of Pediatrics, Georgetown University, Washington DC

Abbreviations: BPD: bronchopulmonary dysplasia • CLD: chronic lung disease • ECMO : extracorporeal membrane oxygenation • HFOV: high-frequency oscillatory ventilation • HFJV: high-frequency jet ventilation • HFFI: high-frequency flow interruptor • HFV: high-frequency ventilation • ICH: intracranial hemorrhage • MAS: meconium aspiration syndrome • PIP: peak inspiratory pressure • PEEP: positive end-expiratory pressure • PVL: periventricular leukomalacia • RDS: respiratory distress syndrome

The first 300 words of the full text of this article appear below.

	Objectives

 
After completing this article, readers should be able to:

1. Summarize the basic rationale for the use of high-frequency ventilation (HFV).
   
2. Summarize the findings of the most important clinical trials of HFV.
   
3. Described the basic characteristics of the various HFV devices available.
   
4. Explain potential problems with interpreting the results of multiple clinical trials comparing HFV with standard therapy.
   
5. Make well-informed choices in the use of HFV.
   

	Introduction

 
Chronic lung disease (CLD) remains the leading cause of prolonged hospitalization as well as significant respiratory and developmental handicap in neonates. Consequently, many efforts in modern neonatal care have focused on methods that might reduce the incidence of this dreaded complication. High-frequency ventilation (HFV) appeared to hold much promise in this area because of its ability to provide excellent gas exchange with lower pressure amplitude. During the 1990s, both high-frequency oscillatory ventilation (HFOV) and high-frequency jet ventilation (HFJV) became firmly established as important tools in the therapeutic armamentarium of neonatologists, based primarily on their potential for reducing the incidence of CLD and effectiveness in treating air leak, respectively. However, despite more than 20 years of laboratory and clinical research, the role of HFV remains controversial. At one end of the spectrum, a minority of clinicians uses HFV as a primary mode of ventilation; at the other extreme are those who view it strictly as a rescue technique, to be used only when conventional ventilation has failed. Most clinicians appear to have an intermediate degree of enthusiasm, using HFV in an early rescue mode for infants who are at high risk of complications with conventional ventilation or who have developed air leak, even though they are maintaining adequate gas exchange on conventional ventilation.

	Types of HFV

 
Three types of high-frequency ventilators are widely in the United States for newborns: the Life Pulse® high-frequency jet ventilator (Bunnell Inc, Salt Lake . . . [Full Text of this Article]