Background: High-frequency jet ventilation (HFJV) is primarily used in neonates but may also have a role in the treatment of infants with congenital heart disease and severe respiratory failure. We hypothesized HFJV would result in improved gas exchange in these infants. Methods: We retrospectively reviewed the records of all pediatric subjects with complex congenital heart disease treated HFJV in the pediatric cardiac ICU between 2014 and 2018. Subjects in whom HFJV was started while on ECMO were excluded. We extracted data on demographics, pulmonary mechanics, gas exchange, subsequent need for ECMO, use of inhaled nitric oxide, and outcomes. Results: We included 27 subjects (weight 4.4 [3.3-5.4] kg; age 2.5 [0.3-5.4] months), 22 (82%) of whom had cyanotic heart disease. Thirteen subjects (48%) survived and 6 (22%) required ECMO. HFJV was started after a median of 8.4 (2.1-26.3) days of conventional mechanical ventilation. Subjects spent a median of 1.2 (0.5-2.8) days on HFJV. Pre-HFJV blood gas results (n=25) were pH 7.22 (7.17-7.31), PaCO2 69 (51-77) mmHg, and PaO2 51 (41-76) mmHg. Initial HFJV settings were peak inspiratory pressure 45 (36-50) cmH2O, rate 360 (360-380) bpm, and inspiratory time 0.02 (0.02-0.03) seconds. Compared to conventional mechanical ventilation, at 4 to 6 hours post HFJV initiation, there were significant improvements in median pH (7.22 vs.7.34, p=0.001) and PaCO2 (69 vs. 50 mmHg, p=0.001), respectively, but no difference in median PaO2 (51 vs. 53 mmHg, p=0.97). Conclusion: HFJV was associated with a decrease in PaCO2 and an increase in pH in infants with congenital heart disease remaining on HFJV 4 to 6 hours after initiation.
Background: High-frequency jet ventilation (HFJV) is primarily used in neonates but may also have a role in the treatment of infants with congenital heart disease and severe respiratory failure. We hypothesized HFJV would result in improved gas exchange in these infants. Methods: We retrospectively reviewed the records of all pediatric subjects with complex congenital heart disease treated HFJV in the pediatric cardiac ICU between 2014 and 2018. Subjects in whom HFJV was started while on ECMO were excluded. We extracted data on demographics, pulmonary mechanics, gas exchange, subsequent need for ECMO, use of inhaled nitric oxide, and outcomes. Results: We included 27 subjects (weight 4.4 [3.3-5.4] kg; age 2.5 [0.3-5.4] months), 22 (82%) of whom had cyanotic heart disease. Thirteen subjects (48%) survived and 6 (22%) required ECMO. HFJV was started after a median of 8.4 (2.1-26.3) days of conventional mechanical ventilation. Subjects spent a median of 1.2 (0.5-2.8) days on HFJV. Pre-HFJV blood gas results (n=25) were pH 7.22 (7.17-7.31), PaCO2 69 (51-77) mmHg, and PaO2 51 (41-76) mmHg. Initial HFJV settings were peak inspiratory pressure 45 (36-50) cmH2O, rate 360 (360-380) bpm, and inspiratory time 0.02 (0.02-0.03) seconds. Compared to conventional mechanical ventilation, at 4 to 6 hours post HFJV initiation, there were significant improvements in median pH (7.22 vs.7.34, p=0.001) and PaCO2 (69 vs. 50 mmHg, p=0.001), respectively, but no difference in median PaO2 (51 vs. 53 mmHg, p=0.97). Conclusion: HFJV was associated with a decrease in PaCO2 and an increase in pH in infants with congenital heart disease remaining on HFJV 4 to 6 hours after initiation.
Authors: Michaela Kollisch-Singule; Harry Ramcharran; Joshua Satalin; Sarah Blair; Louis A Gatto; Penny L Andrews; Nader M Habashi; Gary F Nieman; Adel Bougatef Journal: Front Physiol Date: 2022-03-17 Impact factor: 4.566