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High frequency oscillation in acute lung injury and ARDS

BMJ 2010; 340 doi: (Published 19 May 2010) Cite this as: BMJ 2010;340:c2315
  1. Eddy Fan, instructor1,
  2. Gordon D Rubenfeld, professor2
  1. 1Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, Baltimore, MD 21287, USA
  2. 2Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Canada M4N 3M5

    Definitive evidence about efficacy and quality of life is awaited

    Acute lung injury is a life threatening form of acute respiratory failure with a variety of pulmonary causes (such as pneumonia) or extrapulmonary causes (such as sepsis). Acute respiratory distress syndrome (ARDS) is the most severely hypoxaemic form of acute lung injury. Both acute lung injury and ARDS are common,1 and they are associated with substantial short term mortality,2 with some survivors developing long term morbidity.3

    Mechanical ventilation (with limited tidal volumes and airway pressures) is the cornerstone of treatment for acute lung injury, because no effective drug treatments are available.4 However, mechanical ventilation itself can potentiate lung injury through a variety of mechanisms (for example, overdistension of healthy alveoli and repetitive alveolar opening or collapsing). High frequency oscillation is an alternative ventilatory mode that incorporates the main tenets of “lung protection” to mitigate iatrogenic lung injury—namely, sustained recruitment of collapsed lung using a relatively constant airway pressure, combined with the use of very small, often sub-dead space, tidal volumes.5

    In the linked study (doi:10.1136/bmj.c2327), Sud and colleagues report a meta-analysis …

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