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Moreover, HFOV strategy was associated with a higher mean airway pressures and with a larger use of vasoactive drugs, neuromuscular blockers, and sedatives.
This ventilation technique can be described as a sort of "vibrating CPAP machine": it keeps alveoli open at a constant, less variable, and relatively high mean airway pressure, avoiding tidal overstretch and the cyclic alveolar collapse and recruitment, thus preventing further lung damage [16].
First of all, higher mean airway pressure may decrease venous return or directly affect the function of the right ventricle resulting in severe hemodynamic impairment.
Then HFOV was started with a mean airway pressure of 30 cm H2O, later adjusting the pressure in order to maintain a PaO2 ranging from 55 to 80 mmHg [17, 18].
If mean airway pressure was ≤24 cm H2O for at least 12 h, conventional ventilation could be restarted after 24 h of HFOV.
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