Highfrequency ventilation and inhaled medications

The effective delivery of inhaled medications poses technical difficulties in both conventional ventilators and HFV. Nitric oxide (NO) delivery is particularly controversial and questions of safety and ideal delivery systems persist. NO may be delivered with HFJV devices although, owing to high total gas flows, delivery is cost inefficient. In addition, efficient humidification may sequester active NO and theoretically predispose to the formation of acidic products in ventilator circuits. The higher total NO volume required compared with conventional systems mandates effective expiratory scavenging. In practice, lung volume recruitment with effective HFJV renders the use of NO unnecessary in many patients. If uncertainty exists, HFJV, with its beneficial effects on pulmonary structure, represents a more favorable option than NO application which has cosmetic effects only and does not influence the integrity of lung architecture. Nebulized epoprostenol is an alternative to NO; although costly, it can be effectively delivered via HFJV circuits.

Such technical issues can be overcome by design modifications. The incorporation of atomizers into HFV technology may also offer much more effective delivery of other inhaled medications such as surfactant, a1-antitrypsin, and antibiotics.

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