The Efficacy of High-Frequency Oscillatory Ventilation in Pediatric and Adult Patients

High-frequency oscillatory ventilation (HFOV) is a promising rescue therapy for acute respiratory distress syndrome (ARDS) and acute lung injury, especially when conventional mechanical ventilation has failed. HFOV is a unique ventilatory mode in which it delivers low tidal volumes of breath in very high frequencies utilizing high mean airway pressures. This ventilation mode keeps the collapsed alveoli open and prevents the cyclic derecruitment of the lung while minimizing alveolar overdistension. Hence, HFOV is considered a suitable lung-protective ventilation strategy for people at risk of development of ventilator-induced lung injury. However, there are several controversies surrounding the use of HFOV, including its use as an early treatment for ARDS, its effectiveness in reducing mortality, and its efficacy in oxygenation improvement for high-risk clinical subpopulations, in addition to the associated adverse effects. Therefore, optimal and safe application of HFOV as rescue therapy requires careful HFOV titration based on each individual patient, along with monitoring of important physiological parameters. In this narrative review we aim to explore current evidence regarding the efficacy of HFOV in pediatric and adult patients, focusing on the physiological mechanism of HFOV and its efficacy in oxygenation improvement for management of respiratory failure and ARDS, in addition to clinical challenges and current limitations to HFOV. Future studies should target subpopulations of patients who may benefit from HFOV, along with implementation of consistent protocols for HFOV.