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While survival rates for extremely premature or very low-birth-weight infants have increased, the incidence of chronic lung disease from ventilator-induced lung injury remains high. For this reason, there has been a shift to implement lung protective strategies in neonatology to minimize bronchopulmonary dysplasia. The goal of ventilation has been to limit volutrauma and oxygen toxicity to protect premature lung tissue. Developed in the 1970s, high-frequency oscillatory ventilation (HFOV) is a form of lung protective ventilation used in neonates who fail conventional ventilation. Its use has been shown to decrease lung injury by the mechanisms above. This course focuses on 3 main points: effective use of HFOV, indications for its use, and clinical implications. It reviews the mechanism and implementation of HFOV in neonates, empowering healthcare professionals with the knowledge to provide optimal care for the most vulnerable patients. This activity also highlights the role of an interprofessional team in improving ventilatory management in neonates with lung disease. Objectives: Apply the concepts of high-frequency oscillation to neonatal ventilatory management. Implement an open lung strategy when using the oscillator. Identify patients who could benefit from high-frequency oscillatory ventilation. Collaborate with all members of the interprofessional team to treat infants with appropriate ventilation strategies based on their disease processes. Access free multiple choice questions on this topic.

Greater than 75% of infants born less than 27 weeks gestation require some form of mechanical ventilation to survive.[1]While survival rates for extremely premature (less than 28 weeks) or very low-birth-weight (VLBW) infants have increased, the incidence of chronic lung disease (CLD) from ventilator-induced lung injury remains high.[2] For this reason, effective lung ventilation and oxygenation are key in preventing CLD. The major risk factors for the development of CLD include immature lungs, oxygen toxicity, and ventilator-induced lung trauma.[2][3] The term bronchopulmonary dysplasia (BPD) was introduced in 1967 by Northway et al,[4] and is still used to describe infants who are dependent on oxygen beyond 28 days after birth.[5] While the pathogenesis of BPD has many factors, invasive mechanical ventilation is a primary risk factor. The most common cause of morbidity of prematurity is BPD. For this reason, research has focused on lung protective strategies to limit the development of CLD. Developed in the 1970s, high-frequency oscillatory ventilation (HFOV) is a form of lung protective ventilation that may be used as a primary mode of ventilation in neonates or for those who fail conventional ventilation. HFOV functions by producing small tidal volumes generated by an oscillatory piston to minimize volutrauma.[6][3] While using small tidal volumes, HFOV can also prevent atelectasis, another major component of ventilator-induced lung injury.[3] Similar to conventional ventilation, oxygenation is controlled by the mean airway pressure (MAP) and the fraction of inspired oxygen (FiO2), while ventilation is controlled by the amplitude and frequency of oscillations. Unlike conventional ventilation, which is more likely to induce lung injury through shearing forces, high-frequency oscillation maintains alveolar volume and, therefore, prevents this shearing force.[4] HFOV strategies focus on limiting tidal volume to prevent volutrauma for extremely premature infants.

Implementation of HFOV in the NICU underscores the role of the interprofessional team in improving ventilatory management in neonates with lung disease. This form of ventilation highlights the coordination required between physicians, advanced care practitioners, pharmacists, nurses, and respiratory therapists to provide optimal care to each patient. Prioritizing patient-centered care necessitates tailoring HFOV strategies to the individual needs of each neonate. Engaging with the family, providing education and support, and involving them in care decisions are essential components of a holistic approach. High-frequency ventilation continues to be used as a rescue strategy in neonates who fail conventional ventilatory management. As discussed, this mode of ventilation may also be used as a lung-protective strategy to prevent CLD. Coordinated care involves aligning the efforts of all team members, from initial assessment to ongoing monitoring and adjustments in HFOV settings. This ensures that the care plan is consistently applied and adapted as needed based on the neonate's response. Regular review of outcomes data and continuous quality improvement initiatives help in refining HFOV practices. Prioritizing patient safety involves rigorous monitoring for potential complications, ensuring all equipment is functioning correctly, and adhering to protocols designed to minimize risks associated with HFOV. Enhanced team performance is achieved through ongoing training, simulation exercises, and debriefings to ensure all interprofessional team members are proficient in HFOV techniques and can respond effectively to any situation. Continuous professional development and feedback loops contribute to a high-performing team dedicated to the best possible neonatal care.