The role of high-frequency oscillatory ventilation in the treatment of acute respiratory failure in adults.

PURPOSE OF REVIEW: High-frequency oscillatory ventilation (HFOV) is increasingly used in adults with the acute respiratory distress syndrome (ARDS), who remain hypoxemic during conventional mechanical ventilation. In this review, we will summarize the trials evaluating HFOV in adults with ARDS and discuss issues relevant to the clinician regarding the use of HFOV.

RECENT FINDINGS: Several observational and randomized trials support the safety of HFOV and improvements in oxygenation in adult patients with severe ARDS, who remain hypoxemic during conventional mechanical ventilation.

SUMMARY: HFOV theoretically meets the goals of lung-protective ventilation. On the basis of the current evidence, HFOV is associated with improvements in oxygenation in severe, adult ARDS. However, whether HFOV influences mortality, length of ICU stay, ventilator-free days, quality-of-life factors and is cost-effective remains to be determined. Large, prospective, randomized controlled trials such as the ongoing OSCAR and OSCILLATE trials will help further define the role of HFOV in adult ARDS.