Successful use of high-frequency oscillator ventilation for acute respiratory distress syndrome with pneumomediastinum☆

We report the successful use of high-frequency oscillatory ventilation without recruitment maneuvers in a patient with ARDS and severe hypoxemia who developed a pneumomediastinum during conventional mechanical ventilation. High-frequency ventilation is an attractive modality for the treatment of pneumomediastinum, especially when the airway pressures cannot be reduced by variation in the settings of the conventional mechanical ventilator.