What is the role of high-frequency ventilation (HFV) in the treatment of pulmonary interstitial emphysema (PIE)?

Updated: Jun 25, 2019
  • Author: Abhay J Bhatt, MD, MBBS; Chief Editor: Muhammad Aslam, MD  more...
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Answer

Keszler et al found that high-frequency ventilation was safe and more effective than rapid-rate conventional ventilation in the treatment of newborns with pulmonary interstitial emphysema (PIE). [35]  In their study of 144 newborns with PIE, the use of high-frequency ventilation resulted in similar oxygenation and ventilation obtained at lower peak and mean airway pressures. These results suggested that less air would leak into the interstitial spaces in these infants.

Similar effects can be achieved by use of high-frequency oscillatory ventilation (HFOV). A study by Clark et al demonstrated the efficacy of HFOV in 27 low birth weight infants who developed PIE and respiratory failure while on conventional ventilation. [36]  Overall survival in nonseptic patients was 80%. Surviving patients showed continued improvement in oxygenation and ventilation at an increasingly lower fraction of inspired oxygen (FiO2) and proximal airway pressure with resolution of PIE, whereas nonsurvivors progressively developed chronic respiratory insufficiency with continued PIE from which recovery was not possible. [36]

The investigators hypothesized that interstitial air leak is decreased during HFOV because adequate ventilation is provided at lower peak distal airway pressures. [36] Although this mode of ventilation has inherent risks, it can be a very effective tool for experienced clinicians to treat severe diffuse PIE. Note that care must be taken in smaller infants who require a high amplitude to ventilate, because the active exhalation during HFOV may cause small airway collapse and exacerbate gas trapping.

Squires et al also found that low oscillatory frequency of HFOV had some benefits for preterm infants with severe PIE. [37] After transition to low-frequency HFOV, physiologic responses were seen in both unilateral and bilateral PIE, in particular a rapid and sustained improvement in oxygenation in the bilateral group. [37]


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