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Airway complications of jet ventilation in neonates
1Division of Otolaryngology-Head and Neck Surgery, University of New Mexico, Albuquerque.
Abstract:
Four cases of airway complications in infants surviving jet ventilation have been observed at the Children's Hospital of New Mexico. Two cases of necrotizing tracheobronchitis in preterm infants are presented: one was treated with bronchoscopy and removal of the necrotizing tissue; the second was placed on extracorporeal membrane oxygenation, prior to dilation of the affected area. A third child developed subglottic stenosis after intubation with an oversized jet endotracheal tube. A fourth child, with a history of prematurity and jet ventilation as a neonate, was found at 3 years of age to have tracheal webs in the lower third of his airway. Management and follow-up of these four cases, as well as a literature review of the known airway complications of jet ventilation, are presented.
Insights
Jet ventilation can lead to serious airway complications in infants, including tracheobronchitis and subglottic stenosis. Early recognition and management are crucial for improving outcomes in these vulnerable patients.
Area of Science:
- Pediatrics
- Neonatology
- Otolaryngology
Background:
- Jet ventilation is a high-frequency mechanical ventilation technique used in neonates and infants.
- While effective, jet ventilation may be associated with airway injury.
- Understanding these risks is critical for optimizing patient care.
Observation:
- Four cases of infant airway complications following jet ventilation were observed.
- Complications included necrotizing tracheobronchitis, subglottic stenosis, and tracheal webs.
- These occurred in preterm infants and neonates requiring specialized respiratory support.
Findings:
- Two preterm infants developed necrotizing tracheobronchitis, requiring bronchoscopy or ECMO and dilation.
- One infant experienced subglottic stenosis due to an oversized endotracheal tube.
- Another infant presented with tracheal webs at age three after neonatal jet ventilation.
Implications:
- Airway complications are a significant concern in infants undergoing jet ventilation.
- Prompt diagnosis and intervention, including bronchoscopy and surgical procedures, are essential.
- Further research into preventative strategies and long-term outcomes is warranted.