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High-Frequency Ventilation for Acute Lung Injury and ARDS

2000; Elsevier BV; Volume: 118; Issue: 3 Linguagem: Inglês

10.1378/chest.118.3.795

1931-3543

Jerry A. Krishnan, Roy G. Brower,

Intensive Care Unit Cognitive Disorders

In patients with acute lung injury (ALI) and ARDS,conventional mechanical ventilation (CV) may cause additional lunginjury from overdistention of the lung during inspiration, repeatedopening and closing of small bronchioles and alveoli, or from excessivestress at the margins between aerated and atelectatic lung regions. Increasing evidence suggests that smaller tidal volumes(Vts) and higher end-expiratory lung volumes (EELVs) may beprotective from these forms of ventilator-associated lung injury and may improve outcomes from ALI/ARDS. High-frequency ventilation(HFV)-based ventilatory strategies offer two potential advantages over, CV for pateints with ALI/ARDS. First, HFV uses very small, Vts, allowing higher EELVs with less overdistention than ispossible with CV. Second, despite the small Vts, highrespiratory rates during HFV allow the maintenance of normal ornear-normal Paco 2 levels. In this review, theuse of HFV as a lung protective strategy for patients with ALI/ARDS isdiscussed.