To the Editor The recent study in JAMA Pediatrics by Gupta et al,1 “Comparison of High-Frequency Oscillatory Ventilation and Conventional Mechanical Ventilation in Pediatric Respiratory Failure” concluded that the application of high-frequency oscillatory ventilation (HFOV) results in increased mortality.2 To reach this conclusion, the authors drew data from a large database of experiences at 98 US pediatic intensive care units; however, we do not believe their conclusion is supported by their analysis.