Use of high-frequency jet ventilation in neonates with hypoxemia refractory to high-frequency oscillatory ventilation.
OBJECTIVE
To describe the response to high-frequency jet ventilation in infants with hypoxemic respiratory failure unresponsive to high-frequency oscillatory ventilation.


METHODS
This was a retrospective analysis of chart records on demographics, ventilator settings, blood gas analysis and calculated oxygenation index prior to and during the first 7 days of high-frequency jet ventilation in ten consecutive infants.


RESULTS
Before the initiation of high-frequency jet ventilation, the ventilatory mean airway pressure (MAP; cmH2O), fraction of inspired oxygen (FiO2) and oxygenation index on high-frequency oscillatory ventilation were 14.3 +/- 1.3, 0.97 +/- 0.02 and 29 +/- 5, respectively. Three hours after the initiation of high-frequency jet ventilation, the oxygenation index improved to 18 +/- 4 (p < 0.001) and the improvement was sustained during the study period. By 6 h of high-frequency jet ventilation, the FiO2 decreased to 0.62 +/- 0.09 (p < 0.01) and, by 1-3 h of ventilation, the MAP decreased to 10.9 +/- 1.3 (p < 0.01). The improvement in FiO2 persisted for 7 days while, although the MAP remained lower throughout the study, the improvement in MAP failed to reach statistical significance after 72 h. No significant changes in pH, pCO2, or pO2 before or during high-frequency jet ventilation were noted.


CONCLUSIONS
High-frequency jet ventilation improves hypoxemic respiratory failure unresponsive to high-frequency oscillatory ventilation in infants. These findings suggest that not all high-frequency ventilatory devices yield the same clinical results.
Friedlich
P
P
USC Division of Neonatal Medicine, Childrens Hospital Los Angeles and the Women's and Children's Hospital, LAC+USC Medical Center, Los Angeles, California 90027, USA.
Subramanian
N
N
Sebald
M
M
Noori
S
S
Seri
I
I
D000403:Airway Resistance; D006611:High-Frequency Jet Ventilation; D006612:High-Frequency Ventilation; D006801:Humans; D000860:Hypoxia / Q000628:therapy*; D007231:Infant, Newborn; D010100:Oxygen / Q000097:blood; D012131:Respiratory Insufficiency / Q000628:therapy*; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome
D010100:Oxygen