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Comment & Response |

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

Punkaj Gupta, MBBS1,2; Robert M. Kacmarek, PhD, RRT3; Randall C. Wetzel, MBBS4
[+] Author Affiliations
1Division of Pediatric Critical Care, University of Arkansas Medical Center, Little Rock
2Division 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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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

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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
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.
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