E S Mainali1, C Greene, H J Rozycki, G R Gutcher. 1. Department of Pediatrics, Virginia Commonwealth University Health System, Richmond, VA, USA. emainali@comcast.net
Abstract
OBJECTIVE: To evaluate the safety and efficacy of high-frequency jet ventilation for transporting critically ill hypoxic neonates to an extracorporeal membrane oxygenation (ECMO) center. STUDY DESIGN: We conducted a retrospective cohort study of 38 transported neonates. Safety was assessed by the comparison of cardiopulmonary variables before and after transport from referring hospital to our ECMO unit. Efficacy was assessed as the effect on ventilation and efficiency of pulmonary gas exchange after conversion from a conventional mechanical ventilator or a high-frequency oscillator to a high-frequency jet ventilator+/-inhaled nitric oxide. RESULT: The pre- and post transport vital signs remained stable, regardless of the type of ventilator used. Pre-transport pneumothorax was the main problem, but no transport-related deaths occurred. We found significant improvement in the ventilation of the neonates transported with a high frequency jet ventilation+/-inhaled nitric oxide that were deficient in those transported with conventional mechanical ventilation+inhaled nitric oxide (P<0.05). The improvement started before transport upon changing the mode of ventilation to a high-frequency jet ventilator. CONCLUSION: Independent of the use of inhaled nitric oxide, high frequency jet ventilation appears to provide better ventilation than conventional mechanical ventilation and is safe to transport pre-ECMO neonates.
OBJECTIVE: To evaluate the safety and efficacy of high-frequency jet ventilation for transporting critically ill hypoxic neonates to an extracorporeal membrane oxygenation (ECMO) center. STUDY DESIGN: We conducted a retrospective cohort study of 38 transported neonates. Safety was assessed by the comparison of cardiopulmonary variables before and after transport from referring hospital to our ECMO unit. Efficacy was assessed as the effect on ventilation and efficiency of pulmonary gas exchange after conversion from a conventional mechanical ventilator or a high-frequency oscillator to a high-frequency jet ventilator+/-inhaled nitric oxide. RESULT: The pre- and post transport vital signs remained stable, regardless of the type of ventilator used. Pre-transport pneumothorax was the main problem, but no transport-related deaths occurred. We found significant improvement in the ventilation of the neonates transported with a high frequency jet ventilation+/-inhaled nitric oxide that were deficient in those transported with conventional mechanical ventilation+inhaled nitric oxide (P<0.05). The improvement started before transport upon changing the mode of ventilation to a high-frequency jet ventilator. CONCLUSION: Independent of the use of inhaled nitric oxide, high frequency jet ventilation appears to provide better ventilation than conventional mechanical ventilation and is safe to transport pre-ECMO neonates.