High frequency jet ventilation for congenital diaphragmatic hernia

Area of Science:

• Pediatric Surgery
• Neonatal Critical Care
• Respiratory Physiology

Background:

• The optimal use of high-frequency jet ventilation (HFJV) for lung protective stabilization in congenital diaphragmatic hernia (CDH) is not well-defined.
• This study evaluates the experience of using HFJV as both a primary and rescue ventilation mode in CDH management.

Purpose of the Study:

• To describe the center's experience with HFJV in CDH patients.
• To compare outcomes of different ventilation strategies: conventional mechanical ventilation (CMV), HFJV, and a combined CMV/HFJV approach.

Main Methods:

• Retrospective review of liveborn CDH patients (2013-2021).
• Comparison of three groups based on ventilation strategy prior to surgery.
• Outcomes assessed: composite outcome (mortality, ECMO, or oxygen at discharge), ventilation days, and pneumothorax. Multivariate logistic regression was employed.

Main Results:

• 56 patients were analyzed; groups with HFJV often had more severe CDH disease indicators.
• No significant differences were observed in survival, need for ECMO, or pneumothorax occurrence across groups.
• Infants receiving HFJV required longer invasive ventilation and more oxygen at discharge; multivariate analysis showed no association between ventilation mode and outcomes.

Conclusions:

• HFJV demonstrates effectiveness as both a primary and rescue ventilation strategy for congenital diaphragmatic hernia.
• The findings support the use of HFJV in high-risk CDH cases, despite potentially longer ventilation durations.