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Comment & Response |

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

Martin C. J. Kneyber, MD, PhD1,2; Marc van Heerde, MD, PhD3; Dick G. Markhorst, MD, PhD3
[+] 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.
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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.

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September 1, 2014
Sandrine Essouri, MD, PhD; Guilllaume Emeriaud, MD, PhD; Philippe Jouvet, MD, PhD
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.
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
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.
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