High-frequency jet ventilation versus intermittent positive-pressure ventilation

Airway pressures and cardiorespiratory variables were compared for conventional ventilation (CV) and high-frequency jet ventilation (HFJV), at a similar fraction of inspired O2 (FIO2), positive end-expiratory pressure (PEEP) and PaCO2 in 11 ICU patients. For CV and HFJV, respectively, peak (PAP) and mean airway pressures (Paw) were 15.4 and 9.1 mm Hg and 4.4 and 5 mm Hg. Cardiac index (CI) was 2.54 and 2.60 L/min X m2, total systemic vascular resistance index (SVRI) 2846 and 2923 dyne X sec/cm5 X m2, PaO2 207 and 149 torr, and Qsp/Qt 7% and 11%. HFJV decreased significantly PAP and was less likely to produce pulmonary barotrauma. Cardiac indices were not different, indicating that this variable may be affected by Paw. HFJV neither increased nor decreased CI at similar PEEP and PaCO2 as compared to CV. The decrease in PaO2 and increase in Qsp/Qt may be due to small inspired gas volumes potentiating microatelectasis. On the basis of this study, we recommend initiating HFJV at FIO2 of 0.9 and PEEP of 5 cm H2O, and monitoring both PAP and Paw.