Ver el código de «High frequency oscillation ventilation»

==Background==
*High Frequency Oscillation Ventilation (HFOV) is an alternative method for mechanical ventilation in difficult to oxygenate in critically ill [[ARDS]] patients.
*Studied in patients with PaO2/FiO2 < 200
*Goal is to maintain alveolar recruitment for adequate gas exchange and decrease lung injury/atelectrauma 
**Low tidal volumes based around mean airway pressures to keep alveoli open
**Delivered at high frequency

===Pros===
*Limits VILI
*May improve oxygenation when ECMO not available

===Cons===
*No difference or likely to cause harm in adult ARDS patients
*Requires heavy sedation
*Increase mean airway pressures may result in more hemodynamic instability

==Procedure==
''Example protocol from Oscillate trial<ref>Fergusson N, Cook D, Guyatt G. High-frequency Oscillation in Early Acute Respiratory Distress Syndrome. NEJM 2013; 368:795-805</ref>'' 
*Set FiO2 at 100%
*Recruitment maneuver of 40 cmH2O PEEP for 40 seconds
*I:E time of 1:2
*Initiate high frequency ventilation → 3-15 Hz
*VT minimized to keep pH >7.25
**Goal of 1-4 ml/Kg
*Maintain mean airway pressure of 30 cmH2O with pressure adjusted to maintain a PaO2 of 55-80 mmHg
*Reversion to standard ventilation of mean airway pressure was ≤24 cmH2O for 12 hours or anytime when ≤20 cmH2O
*Re-initiation of HFOV if FIO2 >0.4 or PEEP >14 cmH2O for >1 hour in the subsequent 48 hours

'''Targets'''
*pH>7.25
*SpO2 >88% or PaO2 >55mmHg

'''Oxygenation''' altered by:
*FiO2
*Mean airway pressures

'''Ventilation''' altered by:
*Frequency
**Decrease frequency to increase TV and ventilation
*Inspiratory time
*Amplitude of oscillations

==See Also==
{{Mechanical ventilation pages}}

==External Links==
*[http://lifeinthefastlane.com/ccc/high-frequency-oscillation-ventilation-hfov/ Life in the Fast Lane] - for an excellent review and tutorial
*[http://www.nejm.org/doi/full/10.1056/NEJMoa1215554#t=article Oscillate]
*[http://www.nejm.org/doi/full/10.1056/NEJMoa1215716#t=article OSCAR]

==References==
<references/>

[[Category:Pulmonary]][[Category:Critical Care]]