La ventilazione ad alta frequenza nel neonato

High-frequency ventilation (HFV), currently under investigation in three categories: high-frequency positive pressure ventilation (HFPPV), high-frequency jet ventilation (HFJV), and high-frequency oscillation (HFO), is a new form of mechanical ventilation that employs small tidal volumes in relation to dead space and extremely rapid rates, ranging from 1 to 40 Hz. It has a number of theoretical advantages when compared with current methods of conventional ventilation, and provides adequate gas exchange using minimal proximal airway pressure with little circulatory interference. Reports of successful application of the principles of the HFV in the treatment of infants with respiratory distress syndrome and particularly those with severe interstitial emphysema have raised hopes that this technique might prevent barotrauma to the lungs and have stimulated physicians and engineers to develop new equipment that might be useful in ventilating small infants. Approximately 80 infants are known to have been treated with HFV, mostly for short periods of time. In some with pulmonary interstitial emphysema, the only means of ventilating the infant have been with HFV. There is evidence that the technique can produce adequate gas exchange in infants, primarily when employed for a short period of time. As more knowledge is gained about the etiology of chronic neonatal lung disorders and as the questions of serious adverse effects of HFV are answered, it seems likely that a controlled, randomized, clinical trial might be needed in the future to determine whether HFV can decrease the incidence of complications such as air leak, lessen the morbidity, shorten the duration of dependency on the ventilator, and decrease the requirement for oxygen.