introduction: the inappropriate use of mechanical ventilation in acute respiratory distress syndrome may increase the primary lesion and complicate it with a persistent air leak capable of obscuring the diagnosis. the oscillatory high frequency ventilation is an available modality to rescue a refractory air leak at conventional mechanical ventilation. the aim of this paper is to report the effect of this ventilatory support on gas exchange. and on the evolution of the air leak in patients with acute respiratory distress syndrome. methods: the ventilatory support was applied to all the patients admitted between 1999 and 2006 due to acute respiratory distress syndrome, with persistent or recurrent barotrauma that altered the gas exchange. the time of persistence of the air leak, as well as the mortality and morbidity for this group, were described. results: 19 patients whose average age was 17 months were ventilated. before starting ventilation, pao2/fio2 was 66; oxygenation rate was 24, and paco2 was 75 mm hg. its mean duration was 111 h. the air leak was eliminated in 79 % of the cases and it significantly improved the gas exchange. survival at 30 days was 89 %. conclusions: high frecuency ventilation is useful in most of the patients presenting this syndrome complicated with refractory barotrauma, and it is an unquestionable therapeutical option.