Comparison of airway pathologic lesions after high-frequency jet or conventional ventilation

High-frequency jet ventilation in neonates has been associated with airway damage ranging from focal necrosis to complete airway obstruction with mucus and severe necrotizing tracheobronchitis. However, studies have lacked consistent criteria for assessment, and jet ventilation systems have varied widely. We compared autopsy and histopathologic findings in six neonates who died after prolonged jet ventilatory support with findings in six matched controls who died after receiving conventional ventilatory support. Jet ventilation consisted of a pressure-limited, time-cycled, flow-interrupter-type system. The airways of all patients were assessed by the histopathologic scoring system of Ophoven et al. No differences were observed between neonates who received jet ventilation or conventional ventilation. We believe that the risk of airway damage should not preclude the use of jet ventilation, although further monitoring is imperative.