High-frequency jet ventilation

High-frequency jet ventilation (HFJV) is a ventilation mode that has been available to treat neonatal respiratory failure for more than 35 years. Compared to high-frequency oscillatory ventilation, HFJV can support ventilation with relatively lower mean airway pressures and longer passive expiration. As such, HFJV is often used to treat complex respiratory conditions such as pulmonary hypoplasia, severe pulmonary interstitial emphysema, congenital lung diseases and heterogenous lung states (such as evolving chronic lung disease), in addition to rescue therapy for primary respiratory failure. Common to all these conditions is the need to match ventilator settings to the pathophysiological mechanical and end-expiratory needs. There is renewed interest in HFJV as a potential lung protective modality, especially in the most developmentally immature lungs. The aim of this review is to provide a clinical practice summary of HFJV and the application in different lung conditions. IMPACT: High-frequency jet ventilation is most often used in complex neonatal lung conditions such as pulmonary hypoplasia, interstitial emphysema, the most developmentally immature lungs and gas trapping. High-frequency jet ventilation offers theoretical advantages in these conditions compared to other modalities but safe and effective application also requires greater understanding of mode of action. This review aims to provide clinicians with a practical summary of HFJV, specifically an approach to setting HFJV parameters in clinical practice, important clinical considerations and future research priorities to address critical knowledge gaps.