High‐frequency jet ventilation in children with the adult respiratory distress syndrome complicated by pulmonary barotrauma

Abstract

High-frequency jet ventilation (HFJV) was used in 29 children with severe ARDS complicated by pulmonary barotrauma (PBT). Treatment with HFJV was begun when PBT was progressing over a 24-h period while receiving conventional ventilation (CV). The mean (+/- SD) age was 0.95 +/- 1.21 years (range, 0.03-4 years). The most common diagnosis was viral pneumonia (n = 17); other diagnoses included aspiration pneumonitis (n = 4), bacterial pneumonia (n = 3), multiple trauma (n = 2), and near-drowning (n = 3). The Bunnell Life-Pulse ventilator was used at a rate of 240/min or 300/min, with inspiratory time of 0.02 sec. Twenty children survived (69%). Survivors and nonsurvivors had equal disease severity prior to HFJV as assessed by ventilator settings, alveolar-to-arterial oxygen tension gradient, oxygenation index, and blood gas values. Survivors had spent significantly less time on conventional ventilation prior to HFJV than nonsurvivors, with a mean (+/- SD) of 3.7 +/- 2.1 days vs 9.6 +/- 4.5 days, respectively (P < 0.05). Survivors underwent an average of 4.4 +/- 3.9 days of HFJV, which supported adequate gas exchange with lower airway pressures, and produced resolution or significant improvement in airleak on chest radiograph. In conclusion, we speculate that the application of HFJV early in the course of severe hypoxemic respiratory failure complicated by airleak, allows the reduction of airway pressures, thereby minimizing pulmonary barotrauma and allowing the lung to recover from the underlying insult. Further controlled evaluation of HFJV in this high risk group of patients is warranted.

High-frequency jet ventilation in European and North American institutions: developments and clinical practice

“…High frequency jet ventilation was considered in cases where large bronchopleural air leaks persisted and resulted in failure to adequately ventilate the patient's lungs. Minimizing inflation pressures and tidal volumes with HFJV was used to improve or to resolve air leaks in patients with barotrauma resulting from ventilation in the course of severe respiratory distress [23]. High frequency jet ventilation combined with CV in parallel has been employed in patients with acute respiratory failure to optimize ventilation [60].…”

Bi-caval dual lumen venovenous extracorporeal membrane oxygenation and high-frequency percussive ventilatory support for postintubation tracheal injury and acute respiratory distress syndrome

“…High-frequency percussive ventilation is typically used as an advanced mode of mechanical ventilation for severe ARDS and for burn patients with inhalational injury who require aggressive airway clearance. It has been used to minimize barotrauma [6,16] and to improve airway secretion clearance to facilitate lung recruitment and improve compliance [7]. In small randomized trials in children and adults, HFPV has been shown to improve oxygenation and ventilation at lower mean airway pressures than conventional mechanical ventilation [4,17]; however, no randomized trial has shown a survival benefit.…”

High-frequency jet ventilation in European and North American institutions: developments and clinical practice

“…First, HFJV was used as a special ventilation mode during diagnostic or surgical procedures in patients with airway pathology [2±5,20±22]. Second, HFJV was employed as a respiratory support technique to improve gas exchange during severe pulmonary failure (Table 1) in infants, children and adults (47%) [7±11, 23,24]. Furthermore, hand-triggered jet ventilation devices served as emergency tools to manage dif®cult airways (`can't intubate, can't ventilate' situations) with intravenous (i.v.)…”

“…High frequency jet ventilation was considered in cases where large bronchopleural air leaks persisted and resulted in failure to adequately ventilate the patient's lungs. Minimizing in¯ation pressures and tidal volumes with HFJV was used to improve or to resolve air leaks in patients with barotrauma resulting from ventilation in the course of severe respiratory distress [23]. High frequency jet ventilation combined with CV in parallel has been employed in patients with acute respiratory failure to optimize ventilation [60].…”

“…While HFJV resulted in improved ventilation at lower peak and mean airway pressures, improvement of pulmonary interstitial emphysema and lower mortality in newborns in a multicentre controlled trial [7], others failed to demonstrate improvement in morbidity and mortality [61]. Since secondary lung injury related to the aggressiveness of mechanical ventilation rapidly develops, early implementation of HFJV allowing reduction of the high peak inspiratory pressures in the course of pulmonary insuf®ciency has been emphasized [23]. Combination of HFJV with the inspiratory application of nitric oxide (NO) as a selective pulmonary vasodilator was possible, but methaemoglobin concentrations were signi®cantly higher [62].…”