Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.
ADVANCED SEARCH
Log in
Top
Intensive Care Medicine
Published in: Intensive Care Medicine 12/2015

01-12-2015 | Review

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

Authors: Didier Dreyfuss, Jean-Damien Ricard, Stéphane Gaudry

Published in: Intensive Care Medicine | Issue 12/2015

Login to get access

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 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.
Literature
1.
2.
Ferguson ND, Slutsky AS (2008) Point: high-frequency ventilation is the optimal physiological approach to ventilate ARDS patients. J Appl Physiol 104(4):1230–1231CrossRefPubMed
3.
Froese A, Ferguson N (2013) High-frequency ventilation. In: Tobin M (ed) Principles and practice of mechanical ventilation, 3rd edn. McGraw Hill, New York, pp 495–516
4.
Chang HK (1984) Mechanisms of gas transport during ventilation by high-frequency oscillation. J Appl Physiol Respir Environ Exerc Physiol 56(3):553–563PubMed
5.
Cha EJ, Chow E, Chang HK, Yamashiro SM (1988) Lung hyperinflation in isolated dog lungs during high-frequency oscillation. J Appl Physiol 65(3):1172–1179PubMed
6.
The Acute Respiratory Distress Syndrome Network (2000) Ventilation with lower tidal volumes as compared with traditional tidal volumes for acute lung injury and the acute respiratory distress syndrome. N Engl J Med 342(18):1301–8
7.
Papazian L, Forel JM, Gacouin A, Penot-Ragon C, Perrin G, Loundou A et al (2010) Neuromuscular blockers in early acute respiratory distress syndrome. N Engl J Med 363(12):1107–1116CrossRefPubMed
8.
Guerin C, Reignier J, Richard JC, Beuret P, Gacouin A, Boulain T et al (2013) Prone positioning in severe acute respiratory distress syndrome. N Engl J Med 368(23):2159–2168CrossRefPubMed
9.
Dreyfuss D (2004) To consent or not to consent, that is (not) the (sole) question. “And there is nothing new under the sun”. Kohelet (also known as Ecclesiastes), 1:9. Bible. Intensive Care Med 30(2):180–182CrossRefPubMed
10.
11.
Dreyfuss D (2004) Is it better to consent to an RCT or to care? Muetadeltaepsilonnu alphagammaalphanu (“nothing in excess”). Intensive Care Med 31:345–355CrossRefPubMed
12.
The HIFI Study Group (1989) High-frequency oscillatory ventilation compared with conventional mechanical ventilation in the treatment of respiratory failure in preterm infants. N Engl J Med 320(2):88–93CrossRef
13.
Cools F, Askie LM, Offringa M, Asselin JM, Calvert SA, Courtney SE et al (2010) Elective high-frequency oscillatory versus conventional ventilation in preterm infants: a systematic review and meta-analysis of individual patients’ data. Lancet 375(9731):2082–2091CrossRefPubMed
14.
Gupta P, Green JW, Tang X, Gall CM, Gossett JM, Rice TB et al (2014) Comparison of high-frequency oscillatory ventilation and conventional mechanical ventilation in pediatric respiratory failure. JAMA Pediatr 168(3):243–249CrossRefPubMed
15.
Dreyfuss D, Ricard JD, Gaudry S (2015) Ventilation par oscillations à haute fréquence: rideau? Réanimation 24:4–10CrossRef
16.
Amato MBP, Barbas CSV, Medeiros DM, Schettino GDPP, Filho GL, Kairalla RA et al (1995) Beneficial effects of the “open lung approach” with low distending pressures in acute respiratory distress syndrome. Am J Respir Crit Care Med 152:1835–1846CrossRefPubMed
17.
Ware LB, Matthay MA (2000) The acute respiratory distress syndrome. N Engl J Med 342(18):1334–1349CrossRefPubMed
18.
Hamilton PP, Onayemi A, Smyth JA, Gillan JE, Cutz E, Froese AB et al (1983) Comparison of conventional and high-frequency ventilation: oxygenation and lung pathology. J Appl Physiol 55:131–138PubMed
19.
McCulloch PR, Forkert PG, Froese AB (1988) Lung volume maintenance prevents lung injury during high frequency oscillatory ventilation in surfactant-deficient rabbits. Am Rev Respir Dis 137:1185–1192CrossRefPubMed
20.
Fan E, Needham DM, Stewart TE (2005) Ventilatory management of acute lung injury and acute respiratory distress syndrome. JAMA 294(22):2889–2896CrossRefPubMed
21.
Tierney DF (2003) Ventilator-induced lung injury occurs in rats, but does it occur in humans? Am J Respir Crit Care Med 168(12):1414–1415CrossRefPubMed
22.
Dreyfuss D, Saumon G (1998) Ventilator-induced lung injury: lessons from experimental studies (state of the art). Am J Respir Crit Care Med 157:1–30CrossRef
23.
Parker JC, Hernandez LA, Peevy KJ (1993) Mechanisms of ventilator-induced lung injury. Crit Care Med 21:131–143CrossRefPubMed
24.
25.
Webb HH, Tierney DF (1974) Experimental pulmonary edema due to intermittent positive pressure ventilation with high inflation pressures. Protection by positive end-expiratory pressure. Am Rev Respir Dis 110:556–565PubMed
26.
Dreyfuss D, Basset G, Soler P, Saumon G (1985) Intermittent positive-pressure hyperventilation with high inflation pressures produces pulmonary microvascular injury in rats. Am Rev Respir Dis 132:880–884PubMed
27.
Dreyfuss D, Soler P, Basset G, Saumon G (1988) High inflation pressure pulmonary edema. Respective effects of high airway pressure, high tidal volume, and positive end-expiratory pressure. Am Rev Respir Dis 137(5):1159–1164CrossRefPubMed
28.
Dreyfuss D, Saumon G (1992) Barotrauma is volutrauma, but which volume is the one responsible? Intensive Care Med 18:139–141CrossRefPubMed
29.
Dreyfuss D, Saumon G (1993) Role of tidal volume, FRC and end-inspiratory volume in the development of pulmonary edema following mechanical ventilation. Am Rev Respir Dis 148:1194–1203CrossRefPubMed
30.
31.
Tremblay L, Valenza F, Ribeiro SP, Li J, Slutsky AS (1997) Injurious ventilatory strategies increase cytokines and c-fos m-RNA expression in an isolated rat lung model. J Clin Invest 99:944–952PubMedCentralCrossRefPubMed
32.
Mead J, Takishima T, Leith D (1970) Stress distribution in lungs: a model of pulmonary elasticity. J Appl Physiol 28:596–608PubMed
33.
Argiras EP, Blakeley CR, Dunnill MS, Otremski S, Sykes MK (1987) High peep decreases hyaline membrane formation in surfactant deficient lungs. Br J Anaesth 59:1278–1285CrossRefPubMed
34.
Sandhar BK, Niblett DJ, Argiras EP, Dunnill MS, Sykes MK (1988) Effects of positive end-expiratory pressure on hyaline membrane formation in a rabbit model of the neonatal respiratory distress syndrome. Intensive Care Med 14:538–546CrossRefPubMed
35.
Muscedere JG, Mullen JBM, Gan K, Bryan AC, Slutsky AS (1994) Tidal ventilation at low airway pressures can augment lung injury. Am J Respir Crit Care Med 149:1327–1334CrossRefPubMed
36.
Sohma A, Brampton WJ, Dunnill MS, Sykes MK (1992) Effect of ventilation with positive end-expiratory pressure on the development of lung damage in experimental acid aspiration pneumonia in the rabbit. Intensive Care Med 18:112–117CrossRefPubMed
37.
Hubmayr RD (2002) Perspective on lung injury and recruitment: a skeptical look at the opening and collapse story. Am J Respir Crit Care Med 165(12):1647–1653CrossRefPubMed
38.
de Prost N, Saumon G, Dreyfuss D (2011) Modeling the time-course of ventilator-induced lung injury: what can we learn from interspecies discrepancies? Intensive Care Med 37(12):1901–1903CrossRefPubMed
39.
The National Heart, Lung, and Blood Institute ARDS Clinical Trials Network (2004) Higher versus lower positive end-expiratory pressures in patients with the acute respiratory distress syndrome. N Engl J Med 351(4):327–336
40.
Meade MO, Cook DJ, Guyatt GH, Slutsky AS, Arabi YM, Cooper DJ et al (2008) Ventilation strategy using low tidal volumes, recruitment maneuvers, and high positive end-expiratory pressure for acute lung injury and acute respiratory distress syndrome: a randomized controlled trial. JAMA 299(6):637–645CrossRefPubMed
41.
Mercat A, Richard JC, Vielle B, Jaber S, Osman D, Diehl JL et al (2008) Positive end-expiratory pressure setting in adults with acute lung injury and acute respiratory distress syndrome: a randomized controlled trial. JAMA 299(6):646–655CrossRefPubMed
42.
Young D, Lamb SE, Shah S, Mackenzie I, Tunnicliffe W, Lall R et al (2013) High-frequency oscillation for acute respiratory distress syndrome. N Engl J Med. 368:806–813CrossRefPubMed
43.
Dreyfuss D, Ricard JD, Saumon G (2003) On the physiologic and clinical relevance of lung-borne cytokines during ventilator-induced lung injury. Am J Respir Crit Care Med 167(11):1467–1471CrossRefPubMed
44.
Ricard JD, Dreyfuss D, Saumon G (2001) Production of inflammatory cytokines in ventilator-induced lung injury: a reappraisal. Am J Respir Crit Care Med 163(5):1176–1180CrossRefPubMed
45.
Kirby RR, Downs JB, Civetta JM, Modell JH, Dannemiller F, Klein EF et al (1975) High level positive end expiratory pressure (PEEP) in acute respiratory insufficiency. Chest 67:156–163CrossRefPubMed
46.
Briel M, Meade M, Mercat A, Brower RG, Talmor D, Walter SD et al (2010) Higher vs lower positive end-expiratory pressure in patients with acute lung injury and acute respiratory distress syndrome: systematic review and meta-analysis. JAMA 303(9):865–873CrossRefPubMed
47.
Sud S, Sud M, Friedrich JO, Meade MO, Ferguson ND, Wunsch H et al (2010) High frequency oscillation in patients with acute lung injury and acute respiratory distress syndrome (ARDS): systematic review and meta-analysis. BMJ 340:c2327CrossRefPubMed
48.
Minneci PC, Eichacker PQ, Danner RL, Banks SM, Natanson C, Deans KJ (2008) The importance of usual care control groups for safety monitoring and validity during critical care research. Intensive Care Med 34(5):942–947CrossRefPubMed
49.
Silverman HJ, Miller FG (2004) Control group selection in critical care randomized controlled trials evaluating interventional strategies: an ethical assessment. Crit Care Med 32(3):852–857CrossRefPubMed
50.
Fabry B, Maksym GN, Butler JP, Glogauer M, Navajas D, Fredberg JJ (2001) Scaling the microrheology of living cells. Phys Rev Lett 87(14):148102CrossRefPubMed
51.
Huh D, Fujioka H, Tung YC, Futai N, Paine R 3rd, Grotberg JB et al (2007) Acoustically detectable cellular-level lung injury induced by fluid mechanical stresses in microfluidic airway systems. Proc Natl Acad Sci USA 104(48):18886–18891PubMedCentralCrossRefPubMed
52.
Hussein O, Walters B, Stroetz R, Valencia P, McCall D, Hubmayr RD (2013) Biophysical determinants of alveolar epithelial plasma membrane wounding associated with mechanical ventilation. Am J Physiol Lung Cell Mol Physiol 305(7):L478–L484PubMedCentralCrossRefPubMed
53.
Brusasco V, Beck KC, Crawford M, Rehder K (1986) Resonant amplification of delivered volume during high-frequency ventilation. J Appl Physiol (1985) 60(3):885–892
54.
Amato MB, Meade MO, Slutsky AS, Brochard L, Costa EL, Schoenfeld DA et al (2015) Driving pressure and survival in the acute respiratory distress syndrome. N Engl J Med 372(8):747–755CrossRefPubMed
55.
Zivanovic S, Peacock J, Alcazar-Paris M, Lo JW, Lunt A, Marlow N et al (2014) Late outcomes of a randomized trial of high-frequency oscillation in neonates. N Engl J Med 370(12):1121–1130PubMedCentralCrossRefPubMed
56.
Guervilly C, Forel JM, Hraiech S, Demory D, Allardet-Servent J, Adda M et al (2012) Right ventricular function during high-frequency oscillatory ventilation in adults with acute respiratory distress syndrome. Crit Care Med 40(5):1539–1545CrossRefPubMed
57.
Jardin F, Vieillard-Baron A (2007) Is there a safe plateau pressure in ARDS? The right heart only knows. Intensive Care Med 33(3):444–447CrossRefPubMed
58.
Papazian L, Gainnier M, Marin V, Donati S, Arnal JM, Demory D et al (2005) Comparison of prone positioning and high-frequency oscillatory ventilation in patients with acute respiratory distress syndrome. Crit Care Med 33(10):2162–2171CrossRefPubMed
59.
Patroniti N, Zangrillo A, Pappalardo F, Peris A, Cianchi G, Braschi A et al (2011) The Italian ECMO network experience during the 2009 influenza A(H1N1) pandemic: preparation for severe respiratory emergency outbreaks. Intensive Care Med 37(9):1447–1457CrossRefPubMed
60.
Talmor D, Sarge T, Malhotra A, O’Donnell CR, Ritz R, Lisbon A et al (2008) Mechanical ventilation guided by esophageal pressure in acute lung injury. N Engl J Med 359(20):2095–2104PubMedCentralCrossRefPubMed
61.
de Prost N, Dreyfuss D, Saumon G (2007) Evaluation of two-way protein fluxes across the alveolo-capillary membrane by scintigraphy in rats: effect of lung inflation. J Appl Physiol (1985) 102(2):794–802CrossRef
62.
Parker JC, Townsley MI, Rippe B, Taylor AE, Thigpen J (1984) Increased microvascular permeability in dog lungs due to high airway pressures. J Appl Physiol 57:1809–1816PubMed
63.
64.
Broccard A, Shapiro RS, Schmitz LL, Adams AB, Nahum A, Marini JJ (2000) Prone positioning attenuates and redistributes ventilator-induced lung injury in dogs. Crit Care Med 28(2):295–303CrossRefPubMed
65.
Broccard AF, Shapiro RS, Schmitz LL, Ravenscraft SA, Marini JJ (1997) Influence of prone position on the extent and distribution of lung injury in a high tidal volume oleic acid model of acute respiratory distress syndrome. Crit Care Med 25(1):16–27CrossRefPubMed
66.
Marini JC (2013) Mechanical ventilation in the acute respiratory distress syndrome. In: Tobin MJ (ed) Principles and practice of mechanical ventilation. McGraw-Hill, New York, pp 699–726
67.
Brower RG, Matthay M, Schoenfeld D (2002) Meta-analysis of acute lung injury and acute respiratory distress syndrome trials. Am J Respir Crit Care Med 166(11):1515–1517CrossRefPubMed
68.
Eichacker PQ, Gerstenberger EP, Banks SM, Cui X, Natanson C (2002) Meta-analysis of acute lung injury and acute respiratory distress syndrome trials testing low tidal volumes. Am J Respir Crit Care Med 166(11):1510–1514CrossRefPubMed
69.
Gajic O, Dara SI, Mendez JL, Adesanya AO, Festic E, Caples SM et al (2004) Ventilator associated lung injury in patients without acute lung injury at the onset of mechanical ventilation. Crit Care Med 32:1817–1824CrossRefPubMed
70.
Herasevich V, Tsapenko M, Kojicic M, Ahmed A, Kashyap R, Venkata C et al (2011) Limiting ventilator-induced lung injury through individual electronic medical record surveillance. Crit Care Med 39(1):34–39CrossRefPubMed
Metadata
Title
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
Authors
Didier Dreyfuss
Jean-Damien Ricard
Stéphane Gaudry
Publication date
01-12-2015
Publisher
Springer Berlin Heidelberg
Published in
Intensive Care Medicine / Issue 12/2015
Print ISSN: 0342-4642
Electronic ISSN: 1432-1238
DOI
https://doi.org/10.1007/s00134-015-4062-0

Other articles of this Issue 12/2015

Intensive Care Medicine 12/2015 Go to the issue

Editorial

Protocols: help for improvement but beware of regression to the mean and mediocrity

Editorial

Finally, a time and place for electrophysiological testing in critically ill patients?

What's New in Intensive Care

Why is Acinetobacter baumannii a problem for critically ill patients?

Correspondence

Intensive care medicine curricula in Europe

Letter

Nystatin versus amphotericin B to prevent and eradicate Candida colonization during selective digestive tract decontamination in critically ill patients

Imaging in Intensive Care Medicine

A large pediculated moving mass in the left atrium