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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),
69 (51–77) mm Hg, and
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
(69 vs 50 mm Hg; P = .001), respectively, but no difference in median
(51 vs 53 mm Hg; P = .97).
CONCLUSIONS: HFJV was associated with a decrease in
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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