UMEM Educational Pearls

High Frequency Oscillatory Ventilation (HFOV)

  • Although traditionally used in neonates, HFOV is becoming increasingly popular for select adult patients with ALI/ARDS.
  • Benefits of HFOV include:
    • use of smaller tidal volumes than conventional ventilation
    • maintains alveoli open at a relatively constant airway pressure thereby preventing atelectrauma
    • improves ventilation/perfusion
  • Indications for use of HFOV are when:
    • conventional ventilator settings require an FiO2 > 70% and PEEP > 14 cm H2O OR
    • pH < 7.25 despite higher tidal volumes and plateau pressures > 30 cm H2O
  • Key variables, along with suggested initial settings, for HFOV include:
    • Frequency: 4 - 7 Hertz
    • Amplitude: 70 - 90 cm H2O
    • Mean airway pressure: 5 cm H2O greater than last plateau pressure measured on conventional setting
    • Bias flow: 40 L/min
    • Inspiratory time: 33%
    • FiO2: 100%


Stawicki SP, Goyal M, Sarani B. High frequency oscillatory ventilation and airway pressure release ventilation: a practical guide. Journal of Intensive Care Medicine 2009:24(4):215-229.