Neonatal high-frequency jet ventilation.

Ten neonates with intractable respiratory failure were treated with high-frequency jet ventilation (HFJV). Nine had progressive pulmonary air leaks with either bronchopleural fistulas or pulmonary interstitial emphysema as the primary cause of their respiratory failure. Following HFJV, x-ray film evidence of pulmonary air leaks decreased in seven of the nine neonates. PaO2/FIO2 increased in eight of the ten patients (P less than .05), and PaCO2 values decreased in nine of the ten patients (P less than .01). Five patients survived. Three of the six patients exposed to HFJV for more than 20 hours developed significant tracheal obstruction. From this experience, it may be concluded that HFJV can successfully ventilate certain neonates with intractable respiratory failure secondary to progressive pulmonary air leaks. In its present form, long-term neonatal HFJV carries a risk of airway obstruction and/or damage.