Abstract
HFJV has been developed as an alternate mode of mechanical ventilation which employs very small tidal volumes at rapid rates. Its theoretical advantages over conventional ventilation (CV) include less barotrauma and less cardiovascular depression due to lower airway pressures. While HFJV has been used successfully for treating respiratory disorders in adults and neonates, experience with this mode of ventilation in older children is limited. We have reviewed our experience with 22 pts, aged 2 wks to 20 yrs (m±SD 5.1±6.7 yrs) who received HFJV for treatment of respiratory failure (RF) not adequately controlled with CV. The primary diagnosis was pneumonia in 13 pts, ARDS in 7 pts, and cardiogenic shock in 2 pts. Indications for switching from CV to HFJV were high peak inspiratory pressure (PIP) in 14 pts (64%), refractory hypercarbia in 5 pts (23%) and refractory hypoxemia in 3 pts (13%). Nine pts (41%) had one or more pneumothoraces (PN) during CV. HFJV was initiated with driving pressures of 6-43 psi (m±SD 18.6±9.8 psi) and rates of 95-233 breaths/min (m±SD 145±34). PIP decreased from 61±17 cm H2O during CV to 46±15 cm H2O during HFJV and ΔP (PIP-PEEP) decreased from 49±15 cm H2O to 32±15 cm H2O (both p<0.001). Mean PEEP increased slightly, from 11.6±5 cm H2O to 13.5±7 cm H2O (NS). Partial pressure of CO2 was lower during HFJV (40±13 vs 46±10 mmHg, p < 0.05); oxygenation, as measured by arterial:alveolar pO2, did not change. In 4 pts, HFJV was discontinued within 6 hrs due to worsening arterial blood gases. Of the remaining pts, nine were successfully weaned from HFJV and survived, and 9 expired while receiving HFJV. Duration of HFJV ranged from 2 hrs-20 days (m±SD 6.2±5.7 days), and was shorter in survivors (m±SD 5.7±3 days) than in nonsurvivors (m±SD 9.4±7 days). PN developed in 12 pts (54%) during HFJV; no other complications were notea. HFJV may successfully treat some cases of RF refractory to CV.
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Witte, M., Rudloff, A. & Chatburn, R. CLINICAL EXPERIENCE WITH HIGH FREQUENCY JET VENTILATION (HFJV) IN PEDIATRIC PATIENTS. Pediatr Res 21 (Suppl 4), 208 (1987). https://doi.org/10.1203/00006450-198704010-00253
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DOI: https://doi.org/10.1203/00006450-198704010-00253