High-frequency ventilation in the pediatric intensive care unit.

OBJECTIVE: To provide a state-of-the-art review of high-frequency oscillatory ventilation in the management of pediatric patients with respiratory failure.

DATA SOURCES: A thorough analysis of the preclinical and clinical literature regarding the pathophysiology of respiratory failure and the efficacy of high-frequency techniques in the neonatal and pediatric populations.

DATA SYNTHESIS: After an overview of the introduction of high-frequency techniques, the following topical areas are addressed: device vs. strategy, indications for use, disease-specific strategies, additional practical considerations, and the future of high-frequency techniques.

CONCLUSIONS: The ideal ventilatory approach in patients with hypoxemic respiratory failure may be early institution of an "open lung" strategy using high-frequency ventilatory techniques. The mechanisms of gas exchange that are most important during high-frequency ventilation are bulk axial flow, interregional gas mixing, and molecular diffusion. Infants with hyaline membrane disease and congenital diaphragmatic hernia have also responded positively to the implementation of high-frequency techniques. The oxygenation index (mean airway pressure x Fio2 x 100/Pao2) provides useful prognostic information in patients being managed with high-frequency oscillatory ventilation and may help to identify those patients with high predicted mortality to offer additional or experimental therapies. In the future, the combination of high-frequency oscillatory ventilation and partial liquid breathing offers the possibility of partitioning the physiologic changes associated with positive pressure ventilation. This approach may prove to be the ultimate lung-protective ventilatory strategy.