ArticleFrontiers in medicine2026
Re-evaluating early high-frequency oscillatory ventilation in moderate-to-severe pediatric ARDS: evidence from a genetic matching analysis.
Article in Frontiers in medicine, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background and aims: Pediatric acute respiratory distress syndrome (PARDS) carries high mortality in pediatric intensive care units (PICUs). The clinical benefit of early high-frequency oscillatory ventilation (HFOV) for moderate-to-severe PARDS remains controversial. This study aimed to compare clinical outcomes between HFOV and conventional mechanical ventilation (CMV) using a robust genetic matching approach. Methods: In this retrospective case-control study, children with moderate-to-severe PARDS admitted to the two PICUs of Chongqing Medical University from January 2012 to June 2024 were analyzed in a pre-specified 7-day landmark cohort (sustained invasive MV ≥ 7 days). Genetic matching in R software was applied to balance baseline characteristics between HFOV and CMV groups. The primary outcome was 28-day mortality; secondary outcomes included ventilator-free days (VFD), PICU-free days (IFD), survival time, and survival rates stratified by pre-intubation PaO Results: After matching, 53 patients were included in each group with well-balanced baseline variables. Sensitivity (Rosenbaum bounds) and robustness (nearest-neighbor matching) analyses confirmed the stability of the matched results. The 28-day mortality was significantly higher in the HFOV group than in the CMV group (49.1% vs. 28.3%, Conclusion: In this 7-day landmark cohort, early HFOV may not provide extra benefit in moderate-to-severe PARDS and might be associated with higher mortality, whereas CMV was linked with lower observed 28-day mortality. Further prospective studies are warranted.
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