Internal Med Medical News about HFOV

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High-Frequency Oscillatory Ventilation (HFOV) and Airway Pressure Release Ventilation (APRV): A Practical Guide
Journal of Intensive Care Medicine, 07/22/09

Stawicki SP et al. – The purpose of this article is to review the evidence and mechanisms underlying each modality and to describe the fundamental steps in initiating, adjusting, and terminating these modes of ventilation.

Exclusive Author Commentary
Babak Sarani, 07/22/09

The only ventilator strategy that has been shown to improve mortality in patients with ARDS/ALI is a low-stretch, low-pressure strategy. However, many patients with severe lung injury will not be able to maintain adequate oxygenation using this strategy. Although "open lung" modalities of ventilation, including APRV and HFOV, have not been shown to impact on mortality, they are known to provide a reliable means to augment oxygenation and overcome hypoxemia. This may allow time for the underlying process to resolve and the lung to heal. The purpose of this article is to help the clinician initiate and titrate ventilator therapy using these modalities. Whereas a randomized prospective study evaluating HFOV against the a low-stretch, low-volume method of mechanical ventilation is about to commence, no such study is planned using APRV. Future efforts to resolve this shortfall in knowledge may be beneficial.