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Research ArticleOriginal Research

High-Frequency Jet Ventilation in Infants With Congenital Heart Disease

Andrew G Miller, Briana L Scott, Rachel M Gates, Kaitlyn E Haynes, Denise A Lopez Domowicz and Alexandre T Rotta
Respiratory Care November 2021, 66 (11) 1684-1690; DOI: https://doi.org/10.4187/respcare.09186
Andrew G Miller
Respiratory Care Services, Duke University Medical Center, Durham, North Carolina.
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  • For correspondence: [email protected]
Briana L Scott
Division of Pediatric Critical Care Medicine, Duke Children’s Hospital, Durham, North Carolina.
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Rachel M Gates
Respiratory Care Services, Duke University Medical Center, Durham, North Carolina.
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Kaitlyn E Haynes
Respiratory Care Services, Duke University Medical Center, Durham, North Carolina.
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Denise A Lopez Domowicz
Division of Pediatric Critical Care Medicine, Duke Children’s Hospital, Durham, North Carolina.
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Alexandre T Rotta
Division of Pediatric Critical Care Medicine, Duke Children’s Hospital, Durham, North Carolina.
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Abstract

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 that HFJV would result in improved gas exchange in these infants.

METHODS: We retrospectively reviewed the records of all pediatric patients with complex congenital heart disease treated HFJV in our pediatric cardiac ICU between 2014 and 2018. Patients in whom HFJV was started while on extracorporeal membrane oxygenation (ECMO) were excluded. We extracted data on demographics, pulmonary mechanics, gas exchange, the subsequent need for ECMO, use of inhaled nitric oxide, and outcomes.

RESULTS: We included 27 subjects (median [interquartile range {IQR}] weight 4.4 [3.3–5.4] kg; median [IQR] 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 (IQR) of 8.4 (2.1–26.3) d of conventional mechanical ventilation. The subjects spent a median (IQR) of 1.2 (0.5–2.8) d on HFJV. The median (IQR) pre-HFJV blood gas results (n = 25) were pH 7.22 (7.17–7.31), Embedded Image 69 (51–77) mm Hg, and Embedded Image 51 (41–76) mm Hg. Median (IQR) initial HFJV settings were peak inspiratory pressure of 45 (36–50) cm H2O, breathing frequency of 360 (360–380) breaths/min, and inspiratory time of 0.02 (0.02–0.03) s. Compared with conventional mechanical ventilation, at 4–6 h after HFJV initiation, there were significant improvements in the median pH (7.22 vs 7.34; P = .001) and Embedded Image (69 vs 50 mm Hg; P = .001), respectively, but no difference in median Embedded Image (51 vs 53 mm Hg; P = .97).

CONCLUSIONS: HFJV was associated with a decrease in Embedded Image and an increase in pH in infants with congenital heart disease who remained on HFJV 4 to 6 h after initiation.

  • pediatric respiratory failure
  • high-frequency ventilation
  • jet ventilation
  • gas exchange
  • congenital heart disease
  • mechanical ventilation
  • ventilation

Footnotes

  • Correspondence: Andrew G Miller MSc RRT-ACCS RRT-NPS FAARC, Respiratory Care Services, Duke University Medical Center, 2301 Erwin Road, Durham, NC 27710. E-mail: Andrew.g.miller{at}duke.edu
  • Supplementary material related to this paper is available at http://www.rcjournal.com.

  • Dr Rotta discloses relationships with Vapotherm and Breas US. Mr Miller serves as Section Editor for Respiratory Care. The other authors have disclosed no conflicts of interest.

  • Copyright © 2021 by Daedalus Enterprises
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Respiratory Care: 66 (11)
Respiratory Care
Vol. 66, Issue 11
1 Nov 2021
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High-Frequency Jet Ventilation in Infants With Congenital Heart Disease
Andrew G Miller, Briana L Scott, Rachel M Gates, Kaitlyn E Haynes, Denise A Lopez Domowicz, Alexandre T Rotta
Respiratory Care Nov 2021, 66 (11) 1684-1690; DOI: 10.4187/respcare.09186

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High-Frequency Jet Ventilation in Infants With Congenital Heart Disease
Andrew G Miller, Briana L Scott, Rachel M Gates, Kaitlyn E Haynes, Denise A Lopez Domowicz, Alexandre T Rotta
Respiratory Care Nov 2021, 66 (11) 1684-1690; DOI: 10.4187/respcare.09186
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Keywords

  • pediatric respiratory failure
  • high-frequency ventilation
  • jet ventilation
  • gas exchange
  • congenital heart disease
  • mechanical ventilation
  • ventilation

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