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

In Reply We appreciate the insightful comments by Kneyber et al, Essouri et al, and Rimensberger et al concerning our article in JAMA Pediatrics comparing the outcomes associated with the use of high-frequency oscillatory ventilation (HFOV) and conventional mechanical ventilation in children with acute respiratory failure.¹ We agree with the limitations of database studies. Owing to the nature of the database used for this study, we lacked important parameters such as peak inspiratory pressure, positive end-expiratory pressure, partial pressure of oxygen and carbon dioxide in arterial blood, fraction of inspired oxygen, the alveolar-arterial difference in partial pressure of oxygen and fraction of inspired oxygen ratio, presence of focal vs diffuse lung disease, use of nitric oxide, and presence of air leak.¹ These were explicitly mentioned in the limitations section of the article. However, we were able to match many important severity of illness variables such as the Pediatric Index of Morality 2 score and Pediatric Risk of Mortality 3 score, arterial catheter use, central venous access, use of hemodialysis catheter, use of extracorporeal membrane oxygenation, cardiopulmonary resuscitation or defibrillation use, a variety of diagnoses, and patient vitals including heart rate and blood pressure.¹