High Frequency oscillatory ventilation , HFOV +VG

High frequency oscillatory ventilation (HFOV) is a mode of ventilation that uses small tidal volumes equal to or smaller than the anatomical dead space. These are delivered at a very rapid rate (300e1500 breaths per minute) on a background of a continuous distending pressure which maintains lung expansion. Whilst it can be used electively as first line ventilation, the inconsistent evidence for benefit means it is most commonly used as rescue therapy in neonates with respiratory failure secondary to a number of conditions which include respiratory distress syndrome (RDS), persistent pulmonary hypertension (PPHN), congenital diaphragmatic hernia (CDH) and meconium aspiration syndrome (MAS). A variety of HFO ventilators exist which push gas actively during inspiration and actively draw it out during expiration. Most modern neonatal ventilators provide this mode with advanced flow and volume measurements enabling some to provide a volume guarantee facility. Our experience is predominantly with the Drager VN500 , however many others are available. In the USA, HFO ventilators have been limited to the SensorMedics device which does not provide any monitoring.