title: Preliminary observations of the use of high-frequency jet ventilation as rescue therapy in infants with congenital diaphragmatic hernia.
abstract: 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.
authors.affiliation: Department of Pediatrics, Duke University, Durham, NC, USA.
authors.forename: Michael A
authors.initials: MA
authors.lastname: Kuluz
authors.forename: P Brian
authors.initials: PB
authors.lastname: Smith
authors.forename: Sarah P
authors.initials: SP
authors.lastname: Mears
authors.forename: Jennifer R
authors.initials: JR
authors.lastname: Benjamin
authors.forename: Elisabeth T
authors.initials: ET
authors.lastname: Tracy
authors.forename: W Lee
authors.initials: WL
authors.lastname: Williford
authors.forename: Ronald N
authors.initials: RN
authors.lastname: Goldberg
authors.forename: Henry E
authors.initials: HE
authors.lastname: Rice
authors.forename: C Michael
authors.initials: CM
authors.lastname: Cotten
mesh_terms: 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
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