High-Frequency Jet Ventilation in Pediatric Acute Respiratory Failure

Abstract

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 was 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 patients who received HFJV in the pediatric ICU of a quaternary care center between 2014 and 2018 were retrospectively reviewed. Premature infants who had not been discharged home were excluded, as were those in whom HFJV was started while on extracorporeal membrane oxygenation. Data on demographics, pulmonary mechanics, gas exchange, and outcomes were extracted and analyzed using chi-square testing for categorical variables, nonparametric testing for continuous variables, and a linear effects model to evaluate gas exchange over time.

RESULTS:

A total of 35 subjects (median age = 2.9 months, median weight = 5.2 kg) were included. Prior to HFJV initiation, median (interquartile range) oxygenation index (OI) was 11.3 (7.2–16.9), ${\mathbf{\text{P}}}_{{\mathbf{\text{aO}}}_{\mathbf{\text{2}}}}{\mathbf{\text{/F}}}_{{\mathbf{\text{IO}}}_{\mathbf{\text{2}}}}$ = 133 (91.3–190.0), pH = 7.18 (7.11–7.27), ${\mathbf{\text{P}}}_{{\mathbf{\text{aCO}}}_{\mathbf{\text{2}}}}$ = 64 (52–87) mm Hg, and ${\mathbf{\text{P}}}_{{\mathbf{\text{aO}}}_{\mathbf{\text{2}}}}$ = 74 (64–125) mm Hg. For subjects still on HFJV (n = 25), there was no significant change in OI, ${\mathbf{\text{P}}}_{{\mathbf{\text{aO}}}_{\mathbf{\text{2}}}}{\mathbf{\text{/F}}}_{{\mathbf{\text{IO}}}_{\mathbf{\text{2}}}}$ , or ${\mathbf{\text{P}}}_{{\mathbf{\text{aO}}}_{\mathbf{\text{2}}}}$ at 4–6 h after initiation, whereas pH increased (P = .001) and ${\mathbf{\text{P}}}_{{\mathbf{\text{aCO}}}_{\mathbf{\text{2}}}}$ decreased (P = .001). For those remaining on HFJV for > 72 h (n = 12), the linear effects model revealed no differences over 72 h for OI, ${\mathbf{\text{P}}}_{{\mathbf{\text{aO}}}_{\mathbf{\text{2}}}}{\mathbf{\text{/F}}}_{{\mathbf{\text{IO}}}_{\mathbf{\text{2}}}}$ , ${\mathbf{\text{P}}}_{{\mathbf{\text{aCO}}}_{\mathbf{\text{2}}}}$ , or mean airway pressure, but there was a decrease in ${\mathbf{\text{F}}}_{{\mathbf{\text{IO}}}_{\mathbf{\text{2}}}}$ while pH and ${\mathbf{\text{P}}}_{{\mathbf{\text{aO}}}_{\mathbf{\text{2}}}}$ increased. There were 9 (26%) subjects who did not survive, and nonsurvivors had higher Pediatric Index of Mortality 2 scores (P = .01), were more likely to be immunocompromised (P = .01), were less likely to have a documented infection (P = .02), and had lower airway resistance (P = .02).

CONCLUSIONS:

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