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Title of Journal: Intensive Care Med

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Abbravation: Intensive Care Medicine

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Springer Berlin Heidelberg

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DOI

10.1002/chin.198721197

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1432-1238

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Did studies on HFOV fail to improve ARDS survival

Authors: Didier Dreyfuss JeanDamien Ricard Stéphane Gaudry
Publish Date: 2015/10/05
Volume: 41, Issue: 12, Pages: 2076-2086
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Abstract

High frequency oscillatory ventilation HFOV has been the subject of extensive physiological research for 30 years and even more so of an intense debate on its potential usefulness in the treatment of acute respiratory distress syndrome ARDS This technique has been enthusiastically promoted by some teams until two highquality randomized clinical trials in adults with ARDS showed that HFOV did not decrease and might have even increased mortality As a consequence of these results physiological concepts such as atelectrauma and biotrauma on which ARDS management with HFOV were based should be reexamined In contrast the concept of volutrauma ie endinspiratory overdistension as the cause for ventilatorinduced lung injury might help explain excess mortality during mechanical ventilation of ARDS when inspiratory volumes are too high This is what might have happened during one of the recent studies on HFOV Failure of this complex technique must be put in perspective with the dramatic improvement of ARDS prognosis with very simple interventions such as tidal volume reduction early pharmacological paralysis and prone positioning which all limited endinspiratory volume

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