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Comment & Response
September 2014

It Is Too Early to Declare Early or Late Rescue High-Frequency Oscillatory Ventilation Dead

Author Affiliations
  • 1Division of Pediatric Intensive Care, Department of Pediatrics, Beatrix Children’s Hospital, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
  • 2Critical Care, Anesthesiology, Perioperative Medicine, and Emergency Medicine (CAPE), University of Groningen, Groningen, the Netherlands
  • 3Division of Pediatric Intensive Care, Department of Pediatrics, VU University Medical Center, Amsterdam, the Netherlands
JAMA Pediatr. 2014;168(9):861. doi:10.1001/jamapediatrics.2014.961

To the Editor High-frequency oscillatory ventilation (HFOV) has been on shaky ground since the publication of 2 trials in adults.1 Especially worrisome were the findings of the OSCILLATE (Oscillation for Acute Respiratory Distress Syndrome Treated Early) trial.2 This trial was stopped prematurely, as there was an increased mortality in patients randomized to HFOV. Both trials questioned the role of HFOV in the management of acute respiratory failure and have left pediatric critical care physicians without many options. Despite the negative outcome of the only pediatric trial, to our knowledge, HFOV is often used in critically ill children when conventional ventilation fails.3 Therefore, Gupta et al4 are to be congratulated for their efforts in examining the effects of pediatric HFOV on patient outcome in a retrospective observational study of patients with acute respiratory failure. Using propensity score matching, they concluded that the application of HFOV was associated with worse outcomes. Furthermore, they stated that their findings were similar to the OSCAR (Oscillation in Acute Respiratory Distress Syndrome) and OSCILLATE trial.