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Review
. 2024 Aug 16;109(5):467-474.
doi: 10.1136/archdischild-2023-325657.

Neonatal high-frequency oscillatory ventilation: where are we now?

Jakob Hibberd  1   2 , Justin Leontini  3 , Thomas Scott  3 , J Jane Pillow  4   5   6 , Martijn Miedema  7 , Peter C Rimensberger  8 , David Gerald Tingay  9   2
Affiliations
Review

Neonatal high-frequency oscillatory ventilation: where are we now?

Jakob Hibberd et al. Arch Dis Child Fetal Neonatal Ed. .

Abstract

High-frequency oscillatory ventilation (HFOV) is an established mode of respiratory support in the neonatal intensive care unit. Large clinical trial data is based on first intention use in preterm infants with acute respiratory distress syndrome. Clinical practice has evolved from this narrow population. HFOV is most often reserved for term and preterm infants with severe, and often complex, respiratory failure not responding to conventional modalities of respiratory support. Thus, optimal, and safe, application of HFOV requires the clinician to adapt mean airway pressure, frequency, inspiratory:expiratory ratio and tidal volume to individual patient needs based on pathophysiology, lung volume state and infant size. This narrative review summarises the status of HFOV in neonatal intensive care units today, the lessons that can be learnt from the past, how to apply HFOV in different neonatal populations and conditions and highlights potential new advances. Specifically, we provide guidance on how to apply an open lung approach to mean airway pressure, selecting the correct frequency and use of volume-targeted HFOV.

Keywords: Intensive Care Units, Neonatal; Neonatology; Respiratory Medicine.

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Conflict of interest statement

Competing interests: DGT has presented on mechanical ventilation, including HFOV, at scientific meetings and workshops supported by mechanical ventilator manufacturers, including SLE Ltd UK and Vyaire Medical (formerly Sensormedics, Carefusion and Acutronic). DGT has not received payment for presentations or consultation and the ventilator manufacturers had no input into content of presentations or this manuscript. JL has ongoing collaboration with 4DMedicalR&D (Melbourne, Australia) developing computational models of flows in airways, including during mechanical ventilation. 4DMedicalR&D was not involved into the content of this manuscript. PR has presented on mechanical ventilation, including HFOV, at scientific meetings and workshops supported by mechanical ventilator manufacturers, including SLE Ltd UK and Vyaire Medical (formerly Sensormedics, Carefusion and Acutronic). He has ongoing consulting activity with Getinge and Metran. JJP has presented on mechanical ventilation, including HFOV at scientific meetings. She has ongoing consulting activity on behalf of her university to deliver webinars, and educational workshops supported by Draeger Medical and her research program has benefited from consumables provided as unrestricted research support from Fisher & Paykel Healthcare, Pari GmBH and Chiesi Farmaceutici S.p.A. MM has presented on mechanical ventilation, including HFOV, at workshops supported by SLE Ltd UK. The authors have no other competing interests to declare.

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