High-Frequency Jet Ventilation in Pediatric Acute Respiratory Failure
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Published on: April 7, 2021
Andrew G Miller1, Kaitlyn E Haynes2, Rachel M Gates2
1Respiratory Care Services, Duke University Medical Center, Durham, North Carolina. andrew.g.miller@duke.edu.
Insights
High-frequency jet ventilation (HFJV) improved ventilation in pediatric patients but did not significantly affect oxygenation. This study evaluated HFJV
Area of Science:
- Pediatric Critical Care Medicine
- Respiratory Physiology
- Mechanical Ventilation
Background:
- High-frequency jet ventilation (HFJV) is typically used for premature neonates.
- Its application in pediatric acute respiratory failure is less understood.
- This study aimed to evaluate HFJV's effectiveness in critically ill children.
Purpose of the Study:
- To assess the impact of HFJV on oxygenation and ventilation in pediatric patients.
- To identify factors associated with outcomes in patients receiving HFJV.
Main Methods:
- Retrospective review of medical records for pediatric patients (2014-2018).
- Exclusion of premature infants and patients on extracorporeal membrane oxygenation.
- Analysis of demographics, pulmonary mechanics, gas exchange, and outcomes using statistical tests.
Main Results:
- HFJV showed no significant change in oxygenation index (OI) at 4-6 hours.
- Ventilation improved, with increased pH and decreased partial pressure of carbon dioxide (PCO2) within 4-6 hours.
- Long-term HFJV (>72 hours) showed sustained improvements in pH and PCO2 but no change in OI.
Conclusions:
- HFJV can improve ventilation in pediatric patients with acute respiratory failure.
- Oxygenation benefits were not significant in this cohort.
- Further research may explore optimal HFJV settings for pediatric populations.
Background:
High-frequency jet ventilation (HFJV) is primarily used in premature neonates; however, its use in pediatric patients with acute respiratory failure has been reported. The objective of this study was to evaluate HFJV use in the pediatric critical care setting. We hypothesized that HFJV would be associated with improvements in oxygenation and ventilation.
Methods:
Medical records of all patients who received HFJV in the pediatric ICU of a quaternary care center between 2014 and 2018 were retrospectively reviewed. Premature infants who had not been discharged home were excluded, as were those in whom HFJV was started while on extracorporeal membrane oxygenation. Data on demographics, pulmonary mechanics, gas exchange, and outcomes were extracted and analyzed using chi-square testing for categorical variables, nonparametric testing for continuous variables, and a linear effects model to evaluate gas exchange over time.
Results:
A total of 35 subjects (median age = 2.9 months, median weight = 5.2 kg) were included. Prior to HFJV initiation, median (interquartile range) oxygenation index (OI) was 11.3 (7.2-16.9), [Formula: see text] = 133 (91.3-190.0), pH = 7.18 (7.11-7.27), [Formula: see text] = 64 (52-87) mm Hg, and [Formula: see text] = 74 (64-125) mm Hg. For subjects still on HFJV (n = 25), there was no significant change in OI, [Formula: see text], or [Formula: see text] at 4-6 h after initiation, whereas pH increased (P = .001) and [Formula: see text] decreased (P = .001). For those remaining on HFJV for > 72 h (n = 12), the linear effects model revealed no differences over 72 h for OI, [Formula: see text], [Formula: see text], or mean airway pressure, but there was a decrease in [Formula: see text] while pH and [Formula: see text] increased. There were 9 (26%) subjects who did not survive, and nonsurvivors had higher Pediatric Index of Mortality 2 scores (P = .01), were more likely to be immunocompromised (P = .01), were less likely to have a documented infection (P = .02), and had lower airway resistance (P = .02).
Conclusions:
HFJV was associated with improved ventilation among subjects able to remain on HFJV but had no significant effect on oxygenation.
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