الفهرس 
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Abstract
The present study randomized 200 pediatric moderate and severe ARDS patients over 5 years admitted to Alexandria University PICU. Mechanical ventilation is the cornerstone in their management.
The aim of this study was to compare the outcomes of the initial use of either HFO or CMV in patients with pediatric acute respiratory distress syndrome (PARDS). Evaluated outcomes included: comparing oxygenation improvement by measuring the baseline (after first hour of enrollment) and 2nd day (after 24 hours) values of both PaO2/FiO2and OI, 30-day mortality, air leaks occurrences and cross over rates. Among survivors: length of stay, ventilation days, MV free days till 30-day and PICU ventilator free days were compared.
In PARDS, HFO had a superior advantage in improving oxygenation, yet with no significant mortality improvement, highlighting that mortality is multi-factorial and may not depend only on how fast oxygenation improves. PARDS patients with baseline OI> 16 may have a better chance of survival if treated initially with HFO. In the present study, no case with OI after 24 hours>16 survived. The OI after 24 hours discriminated mortality occurrence with a cut off value >8.5, sensitivity of 72.7% and specificity of 78.5%. LOS didn’t differ among survivors of both groups, so we recommend earlier HFO transition to CMV as soon as OI improves; as it might be an attempt to reduce LOS among HFO treated patients. HFO and CMV might have a co-operative role rather than a competitive role. MODS in PARDS should be early recognized and managed.