Anaesthetic management and high frequency oscillatory ventilation

In an effort to decrease morbidity and mortality, newer modes of mechanical ventilation have been introduced into the critical care arena. One such te chnique, high frequency oscillatory ventilation (HFOV) relies on respirator y rates greater than 150 b.min(-1), small tidal volumes, and the maintenanc e of a constant distending pressure thereby limiting peak inflating pressur e and potentially the incidence of barotrauma. Despite the frequent applica tion of this technique in the ICU setting, there is limited information con cerning its intraoperative use. We present three infants who represent the perioperative applications of HFOV: (i) elective preoperative use to minimi ze lung movement and interference with surgical exposure during thoracotomy and PDA ligation; (ii) intraoperative application when progressive alterat ions in respiratory compliance led to ineffective intraoperative ventilatio n/oxygenation; and (iii) anaesthetic care for a neonate already receiving H FOV. The techniques of HFOV and previous reports of perioperative use are r eviewed.