High-frequency oscillation in adolescents

Background. High-frequency oscillation (HFO) is a widely used lung-protective ventilatory strategy in paediatric and neonatal acute lung injury. Its safe and effective use has been hindered by inadequate recruitment of the lung during oscillation and, until recently, the lack of an adequately powered oscillator for use in adult practice. Methods.We present data from three adolescents with severe acute respiratory distress syndrome (ARDS) who received HFO with the Sensormedics 3100B oscillator after failure of conventional mechanical ventilation. A manual recruitment manoeuvre was used in all patients prior to mechanical ventilation (conventional or HFO) and following tracheal suctioning or disconnection from the ventilator. Changes in oxygenation index were used to assess therapy. Results. All patients showed at least a 25% reduction in oxygenation index within 2 h of HFO, with return to conventional ventilation after 27--65 h. Conclusions. We found HFO, in conjunction with manual recruitment and prone positioning, to be a well-tolerated mode of ventilation in adolescents with ARDS and who were unresponsive to conventional ventilation. Given this success we hope to renew interest in this method for adults with ARDS, together with concurrent use of manual recruitment.