Bringing back the old: time to reevaluate the high-frequency ventilation strategy

OBJECTIVE: To examine the role of frequency in high-frequency ventilation (HFV) on carbon-dioxide (CO2) elimination and lung injury, independent of its effect on tidal volume. STUDY DESIGN: An anatomically representative lung model was attached to a mechanical ventilator capable of providing HFV with a constant volume. CO2 was infused directly into the lung, and a commercially available end-tidal CO2 detector was used to determine CO2 elimination. CO2 elimination and amplitude of pressure transmissions were evaluated using frequencies ranging from 5 to 15 Hz. The pressure-volume index (PVI) was described as the product of the volume and pressures delivered to the lung, a surrogate for lung injury. RESULT: The use of increasing frequencies directly correlated with improved CO2 clearance when keeping the tidal volume fixed, expressed as percent CO2 remaining in the lung at 255 (66.5 (+/- 1.1)%, 50.5 (+/- 0.1)% and 37.8 (+/- 0.3)% at 5, 10 and 15 Hz, respectively, P < 0.05). With a fixed tidal volume, there was a decrease in pressure amplitudes transmitted to the lung with a decline in the PVI (53.9 ( +/- 2.7) mmHg ml(-1), 41.1 (+/- 0.9) mmHg ml(-1) and 23.4 (+/- 3.6) mmHg ml(-1), at 5, 10 and 15 Hz, respectively, P < 0.05). CONCLUSION: Frequency has a direct relationship with CO2 elimination when tidal volume is fixed. Using low delivered tidal volumes and high frequencies may allow for improved ventilation efficacy, while minimizing lung injury.