Comparison of high-frequency jet ventilation with conventional mechanical ventilation for bronchopleural fistula

In seven patients with acute respiratory failure and a bronchopleural fistula, the authors compared gas exchange and volume of gas lost via the chest tube during conventional mechanical ventilation (CV) and high-frequency jet ventilation (HFJV). After the initial comparison, patients were randomized to HFJV or CV, unless one mode of ventilation was clearly superior based on preestablished criteria. In six of the seven patients, oxygenation deteriorated after the switch from CV to HFJV. The ratio of PaCO2 to FI02 declined from 227 +/- 167 to 133 +/- 100 (mean +/- SD, P less than 0.05), and the PaCO2 increased from 47 +/- 13 to 56 +/- 18 mm Hg (P less than 0.05). The mean chest tube leak did not change significantly. Randomization of the mode of ventilation was not performed in any patient because CV was superior by a priori criteria. We conclude that when acute respiratory failure is complicated by a bronchopleural fistula, HFJV with mean airway pressures comparable to those provided during conventional ventilation does not provide satisfactory gas exchange.