We're unable to sign you in at this time. Please try again in a few minutes.
We were able to sign you in, but your subscription(s) could not be found. Please try again in a few minutes.
There may be a problem with your account. Please contact the AMA Service Center to resolve this issue.
Contact the AMA Service Center:
Telephone: 1 (800) 262-2350 or 1 (312) 670-7827  *   Email: subscriptions@jamanetwork.com
Error Message ......
Comment & Response |

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

Sandrine Essouri, MD, PhD1; Guilllaume Emeriaud, MD, PhD1; Philippe Jouvet, MD, PhD1
[+] Author Affiliations
1Pediatric Intensive Care Unit, Centre Hospitalier Universitaire Sainte-Justine, Chemin de la Côte Sainte Catherine, Montréal, Québec, Canada
JAMA Pediatr. 2014;168(9):861-862. doi:10.1001/jamapediatrics.2014.937.
Text Size: A A A
Published online


To the Editor We read with interest the study by Gupta et al1in the recent issue of JAMA Pediatrics. The value of high-frequency oscillatory ventilation (HFOV) in the management of severe acute respiratory failure is a recurrent question for pediatric intensivists.

In this retrospective observational study of a large database, Gupta et al1 compared the outcome of children with acute respiratory failure ventilated with either HFOV or by conventional mechanical ventilation. The authors observed HFOV was associated with worse outcomes and concluded that this result was similar to recently published studies in adults (OSCAR [OlmeSartan and Calcium Antagonists Randomized] and OSCILLATE [Oscillation for Acute Respiratory Distress Syndrome Treated Early]), comparing these 2 ventilator modalities but with one of the inclusion criteria based on the severity of the hypoxemia.2,3 We were intrigued by the authors’ conclusions. Using a retrospective method makes it difficult for their analysis to support their conclusion, as children with the most severe respiratory disease could have had HFOV. In children, hypoxemia is also a major marker of mortality in acute hypoxemic respiratory failure.4,5 The method used by Gupta et al1 to match the children with HFOV and conventional mechanical ventilation was based on a propensity score that did not evaluate acute hypoxemia. Among those included in the logistic regression model to set the propensity score, the only factors that partially reflected hypoxemia were the Pediatric Index of Mortality 2 score, the Pediatric Risk of Mortality 3 score, and the need for extracorporeal membrane oxygenation. The Pediatric Index of Mortality 2 score included the fraction of inspired oxygen alveolar-arterial difference in partial pressure of oxygen ratio and the Pediatric Risk of Mortality 3 score included alveolar-arterial difference in partial pressure of oxygen and partial pressure of carbon dioxide values; these scores reflected other organ dysfunctions and all missing values were considered to be normal. In addition to the matching process, the baseline severity of hypoxemia in the 2 groups could not be compared. As acknowledged in the Discussion, this key adjustment of hypoxemia was missing; therefore, it is possible that the difference in outcome was simply explained by a difference in the severity of the hypoxemia at baseline. The Conclusions should reflect that uncertainty.


Sign in

Purchase Options

• Buy this article
• Subscribe to the journal
• Rent this article ?

First Page Preview

View Large
First page PDF preview





September 1, 2014
Peter C. Rimensberger, MD; Thomas E. Bachman, MSHA
1Service of Neonatology and Pediatric Intensive Care, Department of Pediatrics, University Hospital of Geneva, Geneva, Switzerland
2Mountains Community Hospital, Lake Arrowhead, California
JAMA Pediatr. 2014;168(9):862-863. doi:10.1001/jamapediatrics.2014.940.
September 1, 2014
Martin C. J. Kneyber, MD, PhD; Marc van Heerde, MD, PhD; Dick G. Markhorst, MD, PhD
1Division of Pediatric Intensive Care, Department of Pediatrics, Beatrix Children’s Hospital, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands2Critical 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.
September 1, 2014
Punkaj Gupta, MBBS; Robert M. Kacmarek, PhD, RRT; Randall C. Wetzel, MBBS
1Division of Pediatric Critical Care, University of Arkansas Medical Center, Little Rock2Division of Pediatric Cardiology, University of Arkansas Medical Center, Little Rock
3Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston
4Department of Anesthesiology and Critical Care Medicine, Children’s Hospital Los Angeles, University of Southern California Keck School of Medicine, Los Angeles
JAMA Pediatr. 2014;168(9):863. doi:10.1001/jamapediatrics.2014.934.
Also Meets CME requirements for:
Browse CME for all U.S. States
Accreditation Information
The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
Please click the checkbox indicating that you have read the full article in order to submit your answers.
Your answers have been saved for later.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
Commitment to Change (optional):
Indicate what change(s) you will implement in your practice, if any, based on this CME course.
Your quiz results:
The filled radio buttons indicate your responses. The preferred responses are highlighted
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.


Some tools below are only available to our subscribers or users with an online account.

0 Citations

Sign in

Purchase Options

• Buy this article
• Subscribe to the journal
• Rent this article ?

Related Content

Customize your page view by dragging & repositioning the boxes below.

See Also...