• Guramrinder Singh Thind, Umur Hatipoğlu, Robert L Chatburn, Sudhir Krishnan, Abhijit Duggal, and Eduardo Mireles-Cabodevila.
• Department of Critical Care, Respiratory Institute, Cleveland Clinic, Cleveland, Ohio.
• Respir Care. 2021 Nov 1; 66 (11): 174617511746-1751.

BackgroundThe use of high-frequency oscillatory ventilation (HFOV) is backed by sound physiologic rationale, but clinical data on the elective use of HFOV have been largely disappointing. Nonetheless, HFOV is still occasionally used as a rescue mode in patients with severe hypoxemia. The evidence that supports this practice is sparse.MethodsThis was a retrospective single-center analysis that involved subjects admitted to the medical ICU at Cleveland Clinic, Cleveland, Ohio. We included all adult patients (ages > 18 y) who received rescue HFOV between January 1, 2010, and December 31, 2018, and analyzed their clinical outcomes.ResultsA total of 48 subjects were included in the analysis. The most common primary diagnosis was pneumonia (n = 33 [68.8%]), followed by aspiration (n = 6 [12.5%]) and diffuse alveolar hemorrhage (n = 2 [4.2%]). Switching to HFOV improved oxygenation but also increased vasopressor requirements at 3 h. The mortality rate of the study population was 92% (44/48).ConclusionsOur study did not support utilization of HFOV as a "last-ditch" rescue measure in subjects with respiratory failure. The delayed timing of HFOV initiation and its detrimental hemodynamic effects are among the potential reasons for the high mortality rate.Copyright © 2021 by Daedalus Enterprises.

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