High-Frequency Jet Ventilation in Pediatric Acute Respiratory Failure

Background High-frequency jet ventilation (HFJV) is primarily used in premature neonates; however, its use in pediatric patients with acute respiratory failure has been reported. The objective of this study is to evaluate HFJV use in the pediatric critical care setting. We hypothesized that HFJV would be associated with improvements in oxygenation and ventilation.

Methods: Medical records of all subjects who received HFJV in the pediatric intensive care unit (PICU) of a quaternary care center between 2014 and 2018 were retrospectively reviewed. Premature infants who not been discharged home were excluded as were those in whom HFJV was started while on ECMO. Data on demographics, pulmonary mechanics, gas exchange, and outcomes were extracted and analyzed using chi-squared testing for categorical variables, non-parametric testing for continuous variables, and a linear effects model to evaluate gas exchange over time.

Results: 35 subjects (median 2.9 months, 5.2 kg) were included. Prior to HFJV initiation, median oxygenation index (OI) was 11.3 (7.2-16.9), and P/F 133 (91.3-190.0), pH 7.18 (IQR: 7.11-7.27), PaCO₂ 64 (52-87) mmHg, PaO₂ 74 (64-125) mmHg, For subjects still on HFJV (n=25)4-6 hours after initiation, there was no significant change in OI, P/F or PaO2 whereas pH increased (p=0.001) and PaCO₂ decreased (p=0.001). For those remaining on HFJV for over 72 hours (n=12), the linear effects model revealed no differences over 72 hours for OI, P/F, PaCO₂, or mPaw but there was a decrease in FiO₂, whereas pH and PaO₂ increased. There were no. Nine (26%) did not survive and non-survivors had higher PIM2 scores (p=0.01), were more likely to be immunocompromised (p=0.01), were less likely to have a documented infection (p=0.02), and had lower airway resistance (p=0.024).

Conclusions: HFJV was associated with improved ventilation among subjects able to remain on HFJV but had no significant effect on oxygenation.