Response to the authors

Excerpt

We like to thank the authors for their interest in our manuscript and their positive feedback. High-frequency oscillatory ventilation (HFOV) is used in our unit for any type of PARDS when the patient meets specific criteria as outlined in our manuscript (in summary, peak inspiratory pressure [PIP] > 28–32 cm H₂O, PEEP > 8 cm H₂O, FiO₂ > 0.60, and oxygenation index [OI] increases on three consecutive 1-h measurements despite increasing PEEP) [1]. We understand the author’s perspective that HFOV might be more effective in certain types of PARDS, but we advocate that HFOV should not only be considered in case of refractory hypoxaemia, but also when the bedside team wants to prevent ventilator settings becoming toxic. An individualised lung volume optimisation manoeuvre (such as the staircase incremental–decremental titration of the continuous distending pressure (CDP) helps in identifying patients who have potential for lung recruitability since the response is highly heterogeneous among PARDS [2]. As our data showed, such an individualised manoeuvre can be tolerated well in terms of haemodynamic effects with a minimal risk of barotrauma (in fact, we observed no barotraumas following the manoeuvre in our cohort). …