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High-frequency oscillatory ventilation after cardiac surgery: a treatment for all ages

In a recent issue of Critical Care, Bojan and colleagues [1] reported their experience with early initiation of high-frequency oscillatory ventilation (HFOV) in pediatric cardiac surgery that demonstrated shorter mechanical ventilation times and intensive care stays. Acute lung injury is common in adult patients undergoing surgery, yet there is scant reporting of the intraoperative utility of HFOV [2].

We initiated HFOV in a 49-year-old morbidly obese (body mass index of 69 kg/m2) man who had aortic stenosis, pulmonary hypertension, and decompensated congestive heart failure and who was undergoing aortic valve replacement. Separation from cardiopulmonary bypass (CPB) with inverse-ratio pressure-control ventilation - fraction of inspired oxygen (FiO2) of 1.0 and positive end-expiratory pressure (PEEP) of 18 cm H2O - failed because of hypoxia, defined as an arterial partial pressure of oxygen (PaO2) of 64 mm Hg. HFOV was initiated (mean pressure airway of 33 cm H2O and FiO2 of 1.0), yielding a PaO2 of 74 mm Hg and allowing CPB separation. The patient was transitioned to conventional ventilation on postoperative day 3 and was extubated on postoperative day 5.

This adult patient benefited from HFOV, as did the pediatric population of Bojan and colleagues. Continuous positive intrathoracic pressure is a concern as it may impede venous return and thereby limit cardiac output (CO) [3]. However, the transition from ventilation with PEEP to HFOV usually results in significant changes in oxygenation/ventilation but not in CO [4]. In patients with pulmonary hypertension, HFOV has been demonstrated to increase CO and decrease pulmonary vascular resistance [5]. For our patient, HFOV allowed improved oxygenation without affecting hemodynamics.

HFOV may be a safe and effective therapy to improve oxygenation/ventilation in patients undergoing cardiac surgery and possibly is underused because of unfounded hemodynamic concerns. HFOV needs exploration as a rescue tool after CPB for patients with hypoxia.



cardiac output


cardiopulmonary bypass


fraction of inspired oxygen


high-frequency oscillatory ventilation


arterial partial pressure of oxygen


positive end-expiratory pressure.


  1. 1.

    Bojan M, Gioanni S, Mauriat P, Pouard P: High-frequency oscillatory ventilation and short-term outcome in neonates and infants undergoing cardiac surgery: a propensity score analysis. Crit Care 2011, 15: R259. 10.1186/cc10521

    PubMed Central  Article  PubMed  Google Scholar 

  2. 2.

    Walia G, Jada G, Cartotto R: Anesthesia and intraoperative high-frequency oscillatory ventilation during burn surgery. J Burn Care Res 2011, 32: 118-123. 10.1097/BCR.0b013e318204b38c

    Article  PubMed  Google Scholar 

  3. 3.

    Stawicki SP, Goyal M, Sarani B: High-frequency oscillatory ventilation (HFOV) and airway pressure release ventilation (APRV): a practical guide. J Intensive Care Med 2009, 24: 215-229. 10.1177/0885066609335728

    CAS  Article  PubMed  Google Scholar 

  4. 4.

    Nakagawa R, Koizumi T, Ono K, Tsushima K, Yoshikawa S, Kubo K, Otagiri T: Cardiovascular responses to high-frequency oscillatory ventilation during acute lung injury in sheep. J Anesth 2007, 21: 340-347. 10.1007/s00540-007-0508-z

    Article  PubMed  Google Scholar 

  5. 5.

    Meliones JN, Bove EL, Dekeon MK, Custer JR, Moler FW, Callow LR, Wilton NC, Rosen DB: High-frequency jet ventilation improves cardiac function after the Fontan procedure. Circulation 1991,84(5 suppl):III364-368.

    CAS  PubMed  Google Scholar 

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Correspondence to Ravi S Tripathi.

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The authors declare that they have no competing interests.

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Tripathi, R.S., Stein, E.J., Crestanello, J.A. et al. High-frequency oscillatory ventilation after cardiac surgery: a treatment for all ages. Crit Care 16, 405 (2012).

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  • Cardiac Output
  • Pulmonary Hypertension
  • Acute Lung Injury
  • Aortic Valve Replacement
  • Pulmonary Vascular Resistance