High-frequency oscillatory ventilation can be effective as rescue therapy for refractory acute lung dysfunction.

High-frequency oscillatory ventilation (HFOV) is a technique with limited use in adult patients. The main purpose of this pilot study was to evaluate HFOV on adult trauma patients with refractory lung dysfunction. Refractory lung dysfunction was defined as a PaO2:FiO2 ratio <75 for 1 hour despite maximum support via conventional mechanical ventilation (CMV). Five patients were placed on HFOV after failing CMV between May 1998 and December 1998. The mean PaO2:FiO2 ratio at the time of initiation (52.2+/-4.73) of HFOV increased significantly (P<0.05) by 2 hours (126.8 +21) and was still significantly increased (P<0.01) after 48 hours (181 +26.1) on HFOV. The mean airway pressures (MAPs) and peak pressures were significantly lower (P<0.01) after HFOV. The average MAP of the five patients was 34.6 +1.6 cm H2O at time zero and 25.2 cm H2O after 48 hours of HFOV. The mean peak pressure was 52.4 +3.0 cm H2O at time zero and was 35.8+/-3.01 after termination of HFOV. Survival was 80.0 per cent (four of five patients). In conclusion, all patients improved after initiation of HFOV, and HFOV should be considered in the treatment of patients with acute refractory lung dysfunction.