Key messages

• External high-frequency oscillation (EHFO) differs from negative-pressure ventilation in that ventilation occurs around a variable baseline and both inspiration and expiration are active.

• EHFO can be used for successful ventilation of normal lungs as well as those demonstrating abnormal compliance.

• EHFO improves sputum clearance and may reduce weaning times from ventilatory support.

• Combination ventilation (EHFO plus pressure-controlled ventilation) may improve outcome in acute respiratory distress syndrome (ARDS) secondary to acute lung injury, provided that treatment is instituted before structural lung changes occur.

• EHFO appears to offer no benefit in patients with infective causes of ARDS.

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