• Punkaj Gupta, Jerril W Green, Xinyu Tang, Christine M Gall, Jeffrey M Gossett, Tom B Rice, Robert M Kacmarek, and Randall C Wetzel.
• Division of Pediatric Critical Care, Department of Pediatrics, University of Arkansas Medical Center, Little Rock2Division of Pediatric Cardiology, Department of Pediatrics, University of Arkansas Medical Center, Little Rock.
• JAMA Pediatr. 2014 Mar 1;168(3):243-9.

ImportanceOutcomes associated with use of high-frequency oscillatory ventilation (HFOV) in children with acute respiratory failure have not been established.ObjectiveTo compare the outcomes of HFOV with those of conventional mechanical ventilation (CMV) in children with acute respiratory failure.Design, Setting, And ParticipantsWe performed a retrospective, observational study using deidentified data obtained from all consecutive patients receiving mechanical ventilation aged 1 month to 18 years in the Virtual PICU System database from January 1, 2009, through December 31, 2011. The study population was divided into 2 groups: HFOV and CMV. The HFOV group was further divided into early and late HFOV. Propensity score matching was performed as a 1-to-1 match of HFOV and CMV patients. A similar matching process was performed for early HFOV and CMV patients.ExposureHigh-frequency oscillatory ventilation.Main Outcomes And MeasuresLength of mechanical ventilation, intensive care unit (ICU) length of stay, ICU mortality, and standardized mortality ratio (SMR).ResultsA total of 9177 patients from 98 hospitals qualified for inclusion. Of these, 902 (9.8%) received HFOV, whereas 8275 (90.2%) received CMV. A total of 1764 patients were matched to compare HFOV and CMV, whereas 942 patients were matched to compare early HFOV and CMV. Length of mechanical ventilation (CMV vs HFOV: 14.6 vs 20.3 days, P < .001; CMV vs early HFOV: 14.6 vs 15.9 days, P < .001), ICU length of stay (19.1 vs 24.9 days, P < .001; 19.3 vs 19.5 days, P = .03), and mortality (8.4% vs 17.3%, P < .001; 8.3% vs 18.1%, P < .001) were significantly higher in HFOV and early HFOV patients compared with CMV patients. The SMR in the HFOV group was 2.00 (95% CI, 1.71-2.35) compared with an SMR in the CMV group of 0.85 (95% CI, 0.68-1.07). The SMR in the early HFOV group was 1.62 (95% CI, 1.31-2.01) compared with an SMR in the CMV group of 0.76 (95% CI, 0.62-1.16).Conclusions And RelevanceApplication of HFOV and early HFOV compared with CMV in children with acute respiratory failure is associated with worse outcomes. The results of our study are similar to recently published studies in adults comparing these 2 modalities of ventilation for acute respiratory distress syndrome.

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