Mortality Risk Factors in Preterm Infants Treated with High-Frequency Jet Ventilation

Abstract

BACKGROUND: High-frequency jet ventilation (HFJV) has been used in conjunction with conventional ventilation for premature infants with respiratory failure. We sought to identify parameters that were associated with mortality in subjects who underwent HFJV. METHODS: Subjects were enrolled if birthweight was^2,000 g and they were^34 weeks gestational age. Subjects were excluded if they received HFJV at the time of admission because we aimed to study subjects who failed conventional ventilation. Subject demographics, ventilator parameters, and laboratory data were extracted and analyzed. The Mann-Whitney U-test was used to assess differences in continuous variables, and the chi-square and Fisher exact tests were used for categorical variables between the groups. To assess variables that were predictive of mortality, we used both univariate and multivariate logistic regression analysis. Independent predictors of mortality were identified and used to create a multivariate risk score. Receiver operating characteristic curves were constructed to evaluate the predictive accuracy of the multivariate risk score. RESULTS: A total of 53 premature subjects (n 5 37 male) were studied, of whom 39 (74%) survived to discharge or transfer back to referring hospital. In the univariate model, female sex, older gestational age, higher birthweight, HFJV peak inspiratory pressure at 1 h, and oxygen saturation index at 4 h were associated with mortality. In the final multivariate logistic regression model, female sex (odds ratio 4.1, 95% CI 1.2-19.8, P 5 .044), closed ductus arteriosus (odds ratio 7.7, 95% CI 1.3-39.5, P 5 .016), and oxygen saturation index > 5.5 (odds ratio 6.0, 95% CI 1.5-28.3, P 5 .02) were independent predictors of mortality. CONCLUSIONS: We identified that oxygen saturation index > 5.5 after 4 h of HFJV, female sex, and closed ductus arteriosus were independent predictors of mortality.

High-Frequency Jet Ventilation in Neonatal and Pediatric Subjects: A Narrative Review

“…When initiating HFJV in premature neonates, initial PIP is usually started slightly above (ie, 2-5 cm H 2 O above) the PIP on the conventional ventilator and adjusted for "appropriate" chest wiggle. 12 For patients in the pediatric ICU, the initial PIP may be set in a similar manner, although larger patients may require a high ( 40 cm H 2 O) initial PIP. 8,9 Attenuation of the PIP through the large airways and bronchi results in lower pressure in the terminal airways and alveoli.…”

“…8,9 Despite the lack of high-quality evidence, the use of HFJV may be increasing as there have been a number of single-center experiences published since 2015. [8][9][10][11][12] The purpose of this review is to discuss the physiologic principles behind HFJV, examine the evidence supporting its use in neonatal and pediatric ICUs, give meaningful guidance for clinical application, and highlight potential areas for future research.…”

Unsolved Mysteries: High-Frequency Jet Ventilation in the Neonatal ICU

“…Finally, survival is an important outcome, but in the future we should consider including a composite outcome, such as survival without significant morbidity, in premature neonates because many survivors carry significant morbidities such as cerebral palsy, bronchopulmonary dysplasia, developmental delay, increased hospitalizations, and other long-term health sequelae. 12 The renewed interest in HFJV in the neonatal ICU has illustrated the need for randomized controlled trials investigating HFJV as both a rescue mode like in the study by Wheeler et al 8 and as an elective strategy to prevent bronchopulmonary dysplasia. Given the relative rarity of HFJV use and logistical challenges associated with a randomized controlled trial, it is likely that observational data will be our best source of evidence for now.…”

“…7 Despite the lack of high-quality, high-level supporting data, HFJV is widely used in neonatal ICUs as a rescue mode and as an elective mode intended to reduce bronchopulmonary dysplasia and chronic lung disease. In this issue of RESPIRATORY CARE, Wheeler et al 8 reported on risk factors for mortality in 53 premature neonates treated with rescue HFJV in their quaternary neonatal ICU. The overall survival rate was 74%, and univariate analysis revealed gender, gestational age, postmentrual age at HFJV initiation, born < 28 weeks gestational age, weight, length of stay, arterial access, inhaled nitric oxide, patent ductus arteriosus, F IO 2 , peak inspiratory pressure at 1 h after HFJV initiation, and oxygen saturation index at 4 h after HFJV were all statistically different between survivors and non-survivors.…”

The Oxygen Saturation Index as Early Predictor of Outcomes in Congenital Diaphragmatic Hernia

“…As the OSI could be monitored continuously and transcutaneously, in contrast to the commonly used OI that requires blood sampling, the OSI might be used for real-time and bedside guidance during the crucial first hours of life. We have recently demonstrated that both the OI and OSI predict adverse outcomes in infants with CDH, but up until now, studies have focused on either the predictive value of OSI measurements at pre-specified time points or the comparability of paired OI and OSI measurements [9][10][11][12][13][14][15]. Hence, studies on the predictive value of continuous OSI measurements are scarce, especially in infants with CDH [16].…”