Intensive Care Medicine

, Volume 41, Issue 12, pp 2076–2086 | Cite as

Did studies on HFOV fail to improve ARDS survival because they did not decrease VILI? On the potential validity of a physiological concept enounced several decades ago

  • Didier DreyfussEmail author
  • Jean-Damien Ricard
  • Stéphane Gaudry


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 high-quality 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, i.e., end-inspiratory overdistension, as the cause for ventilator-induced 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 end-inspiratory volume.


HFOV Ventilator-induced lung injury Volutrauma Atelectrauma PEEP 


Compliance with ethical standards

Conflicts of interest

All authors have no conflict of interest related to this article.


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Copyright information

© Springer-Verlag Berlin Heidelberg and ESICM 2015

Authors and Affiliations

  • Didier Dreyfuss
    • 1
    • 2
    • 3
    Email author
  • Jean-Damien Ricard
    • 1
    • 2
    • 3
  • Stéphane Gaudry
    • 1
    • 2
    • 4
  1. 1.Service de Réanimation Médico-Chirurgicale, Hôpital Louis MourierAP-HPColombesFrance
  2. 2.UMR 1137, IAME, INSERMParisFrance
  3. 3.UMR 1137, IAMEUniv Paris Diderot, Sorbonne Paris CitéParisFrance
  4. 4.UMR 1123, ECEVEUniv Paris Diderot, Sorbonne Paris CitéParisFrance

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