Protective ventilation in ARDS: as soon as possible. An immediate use of HFOV

OBJECTIVE To report the immediate use of High-Frequency Oscillatory ventilation in an adult acute respiratory distress syndrome. DESIGN Case report. SETTING Intensive care unit at the Military Teaching Hospital of Toulon. PATIENT A 64-yr-old Caucasian male who developed acute respiratory distress syndrome in the course of severe falciparum malaria. INTERVENTION Initial use of HFO to minimise ventilator-induced lung injury. MEASUREMENT AND MAIN RESULTS Rapid improvement of PaO2/fraction of inspired oxygen from 172 mmHg (NIV) to 310 mmHg with HFO. No ventilator-induced injury on CT scan after 5 days of invasive ventilation. CONCLUSION In contrast with previous studies, we successfully used lung protective ventilation with HFO immediately. Further studies, with immediate, rather than rescue use of HFO ventilation, are needed.