High Frequency Oscillation: The End?

Abstract

High frequency oscillatory ventilation (HFO) has been the subject of extensive physiological research for 30 years and even more so of an intense debate on its potential usefulness in the treatment of acute respiratory distress syndrome (ARDS). This potentially harmful technique has been enthusiastically promoted by some teams until two high-quality randomized clinical trials on ARDS in adults caused the ruin of this house of cards. Indeed, physiological concepts such as atelectrauma and biotrauma on which HFO was based during ARDS were highly disputable. On the contrary, the concept of volotrauma i.e., end-inspiratory overdistension as the responsible for ventilator-induced lung injury allowed prediction of excess mortality during mechanical ventilation of ARDS when inspiratory volumes are too high. This is what happened during a recent study on HFO. This resounding failure of a complex and potentially dangerous technique must be put in perspective with the dramatic improvement of ARDS prognosis with very simple interventions such as tidal volume reduction, early pharmacological paralysis and prone positioning.