Preliminary observations of the use of high-frequency jet ventilation as rescue therapy in infants with congenital diaphragmatic hernia.
OBJECTIVE
Congenital diaphragmatic hernia (CDH) is associated with mortality of 10% to 50%. Several investigators have reported outcomes from centers using high-frequency oscillatory ventilation in their management of CDH, but there are no recent reports on use of high-frequency jet ventilation.


METHODS
During the study period from January 2001 until August 2007, infants with CDH who were cared for at Duke University Medical Center received high-frequency jet ventilation as a rescue mode of high-frequency ventilation. We compared actual survival with predicted survival for infants treated only with conventional ventilation vs those rescued with high-frequency jet ventilation after failing conventional ventilation.


RESULTS
Survival for the 16 infants that received high-frequency jet ventilation was predicted to be 63%; actual survival was 75%. Survival for the 15 infants that received only conventional ventilation was predicted to be 83%; actual survival was 87%. We observed no significant survival benefit for high-frequency jet ventilation, 8.0% (95 confidence interval, -22.0% to 38.1%; P = .59).


CONCLUSIONS
Although our sample size was small, we conclude with consideration of the absolute results, the degree of illness of the infants, and the biologic plausibility for the intervention that high-frequency jet ventilation is an acceptable rescue ventilation mode for infants with CDH.
Kuluz
Michael A
MA
Department of Pediatrics, Duke University, Durham, NC, USA.
Smith
P Brian
PB
Mears
Sarah P
SP
Benjamin
Jennifer R
JR
Tracy
Elisabeth T
ET
Williford
W Lee
WL
Goldberg
Ronald N
RN
Rice
Henry E
HE
Cotten
C Michael
CM
D005260:Female; D006548:Hernia, Diaphragmatic / Q000628:therapy*; D065630:Hernias, Diaphragmatic, Congenital; D006611:High-Frequency Jet Ventilation; D006801:Humans; D007231:Infant, Newborn; D008297:Male; D009657:North Carolina; D016019:Survival Analysis
J Pediatr Surg. 2004 May;39(5):657-60
15136994
J Pediatr Surg. 2001 Jan;36(1):141-5
11150453
Crit Care Med. 2000 Jan;28(1):227-31
10667528
Pediatr Pulmonol. 1994 Oct;18(4):239-43
7838623
Biol Neonate. 1987;51(5):241-8
3647799
J Cardiothorac Vasc Anesth. 1991 Aug;5(4):320-6
1873510
Crit Care Med. 2000 Jan;28(1):282-4
10667554
J Pediatr Surg. 1999 Dec;34(12):1813-7
10626861
J Pediatr Surg. 2008 May;43(5):783-7
18485938
Arch Dis Child Fetal Neonatal Ed. 1996 May;74(3):F172-6
8777679
Eur J Pediatr. 1999 Oct;158(10):780-4
10486074
J Pediatr Surg. 1998 Sep;33(9):1331-7
9766347
Pediatrics. 1985 Apr;75(4):657-63
3982897
J Perinatol. 2007 Sep;27(9):535-49
17637787
J Pediatr Surg. 1992 Aug;27(8):997-1001; discussion 1001-2
1403564
J Clin Anesth. 2000 Jun;12(4):308-14
10960204
Br J Surg. 1971 May;58(5):342-6
5574718
J Pediatr. 1987 Apr;110(4):617-22
3470493
Eur J Pediatr Surg. 2001 Feb;11(1):3-7
11370980
Pediatr Pulmonol. 1989;7(1):35-41
2771469
J Pediatr Surg. 2002 Mar;37(3):357-66
11877648
Intensive Care Med. 2000 Jul;26(7):934-41
10990109
Neonatology. 2009;96(3):137-49
19325248
Teratology. 1992 Dec;46(6):555-65
1290156
Pediatr Surg Int. 2005 Mar;21(3):143-7
15756563
J Pediatr Surg. 2004 Mar;39(3):313-8; discussion 313-8
15017544
Am J Respir Crit Care Med. 2002 Oct 1;166(7):911-5
12359645
J Pediatr Surg. 2003 May;38(5):729-32
12720181
Am Rev Respir Dis. 1987 Oct;136(4):947-50
3662245
J Pediatr. 1987 Sep;111(3):423-31
3625414
J Pediatr Surg. 2007 Sep;42(9):1526-32
17848243
Circulation. 1991 Nov;84(5 Suppl):III364-8
1934431