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November 25, 1983

High-Frequency Ventilation: A New Approach to Respiratory Support

Author Affiliations

From the Department of Anesthesia, The Children's Hospital, and Harvard Medical School, Boston.

JAMA. 1983;250(20):2845-2847. doi:10.1001/jama.1983.03340200079036

RESPIRATORY failure from parenchymal lung disease was the admitting diagnosis for 139 of more than 2,200 admissions to the Multidisciplinary Intensive Care Unit at The Children's Hospital Medical Center in Boston during 1982. Despite maximal medical support, 32 of these children died, an unacceptable mortality that demands ongoing investigation of new, innovative, and possibly more effective forms of support.

The conventional therapeutic approach to patients with respiratory failure includes safe and effective support of cardiovascular function and gas exchange while treating the underlying pulmonary pathological condition. The present methods of respiratory support include increased ambient oxygen, continuous positive airway pressure, and, ultimately, intermittent positive-pressure breathing. In most patients, gas exchange can be supported by these techniques; but in some situations, ventilationperfusion relationships are so deranged that death results from hypoxemia and/or respiratory acidosis. In addition to clinical limitations, respiratory support can also produce complications. These include oxygen toxicity and barotrauma