During HFOV, low tidal volumes can lead to:

In high-frequency oscillatory ventilation (HFOV), low tidal volumes can lead to under-ventilation because the volume of gas exchanged with each breath is reduced. The primary purpose of using HFOV is to minimize barotrauma and volutrauma by delivering smaller volumes of air while still maintaining adequate lung recruitment. However, if the tidal volumes are too low, there may not be enough gas exchange occurring to adequately meet the patient’s needs for oxygen and carbon dioxide removal.

This scenario is further complicated by the fact that, in HFOV, the frequency of breaths is typically much higher than that of conventional ventilation. Therefore, if tidal volumes are not set appropriately, it can lead to an insufficient total minute ventilation, which is crucial for maintaining stable arterial blood gas levels. The goal in using HFOV is to strike a balance between adequate ventilation and preventing lung injury, but excessive reductions in tidal volume can hinder the effectiveness of this balance and result in insufficient ventilation.