oa Southern African Journal of Critical Care - How do we use high-frequency oscillation : primary ventilation, rescue therapy or switch directly to early extracorporeal membrane oxygenation? - research

Volume 35 Number 2
  • ISSN : 1562-8264
  • E-ISSN: 2078-676X



More than 40 years ago, the paediatric intensivist Charlie Bryan accidently discovered the concept of oscillation during laboratory experiments.[1] In high-frequency oscillation (HFO), a piston generates high-speed, low-volume waves to enable gas exchange, while continuous gas flow maintains lung recruitment throughout the ventilation cycle. The patient is ventilated on the deflation limb of the pressure-volume curve where compliance is better and, theoretically, develops less ventilator-induced lung injury (VILI).[2] The usefulness of HFO has been questioned following adult respiratory distress syndrome (ARDS) trials refuting the benefit of HFO above conventional mechanical ventilation (CMV). The large ARDS OSCILLATE[3] multicentre randomised control trial (RCT) compared early HFO to lung-protective CMV. The study was stopped early because of significantly lower in-hospital survival in the HFO group. Also, significantly more vasoactive, sedation and paralysis drugs were used in this group.

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