High-frequency oscillatory ventilation with tracheal gas insufflation: the rescue strategy for brain-lung interaction

The occurrence of moderate to severe acute respiratory distress syndrome due totraumatic brain injury is not uncommon and is associated with an extremely highincidence of morbidity and mortality. Owing to the complex interaction betweenthe lung and brain, protective ventilation for the lung with lower tidal volumeand higher positive end-expiratory pressure with or without mild hypercapniamight be harmful for the brain, and maintaining normocapnia or mild hypocapniaby increasing tidal volume or respiratory rate (or both) with lower positiveend-expiratory pressure levels for protecting the brain might lead toventilator-induced lung injury. Balancing the end-point between lungs and brainbecomes a challenging issue, and non-conventional modes of mechanicalventilation might play a role in the more difficult clinical cases. In thiscommentary, the authors discuss the rationale, based on the physiologicprinciple of targeting both vital organs, of applying high-frequency oscillationand tracheal gas insufflation in acute respiratory distress syndrome patientswith traumatic brain injury.