TY - JOUR T1 - Tidal volume, recruitment and compliance in HFOV: same principles, different frequency JF - European Respiratory Journal JO - Eur Respir J SP - 291 LP - 293 DO - 10.1183/09031936.00020012 VL - 40 IS - 2 AU - J. Jane Pillow Y1 - 2012/08/01 UR - http://erj.ersjournals.com/content/40/2/291.abstract N2 - The widespread clinical introduction of high-frequency oscillatory ventilation (HFOV) for the treatment of respiratory distress syndrome in neonates in the late 1980s and early 1990s heralded a new era of understanding of the optimal approach to lung volume (VL) recruitment, which embraced the concept of open lung ventilation [1]. The promotion of HFOV as a means of independently controlling oxygenation and ventilation contributed to the ease with which it was accepted as a clinical treatment in many neonatal units. Unlike mechanical ventilation at physiological breathing rates where changes in ventilator settings on contemporary ventilators inevitably affect both oxygenation and ventilation, traditional teaching of HFOV promoted changes in mean airway pressure as the means of influencing arterial oxygen tension and alterations to proximal pressure amplitude (ΔP) and frequency (f) of the oscillatory waveform as the determinants of arterial carbon dioxide tension (Pa,CO2) [2]. Like any intensive care technology, however, successful and safe application of HFOV is highly dependent on fully understanding the specific nuances of this ventilatory modality.As recognised previously, there are clear changes in compliance during recruitment of the atelectatic lung [3]. During ventilation at conventional breathing rates, as VL is recruited, lung compliance improves and this is accompanied by increased tidal volume (VT) to which the clinical response is normally a reduction in minute volume: in synchronised modes, this is most often achieved via a reduction in ΔP or targeted VT rather than a reduction in respiratory rate.Changes in compliance [4–7] and lung tissue resistance [5] have also been widely recognised during volume recruitment achieved with HFOV. In this issue of the European Respiratory Journal, Miedema et al. [8] present an elegant study … ER -