BACKGROUND: High-frequency jet ventilation (HFJV) has been used in conjunction with conventional ventilation for premature infants with respiratory failure. We sought to identify parameters that were associated with mortality in subjects who underwent HFJV. METHODS: Subjects were enrolled if birthweight was^2,000 g and they were^34 weeks gestational age. Subjects were excluded if they received HFJV at the time of admission because we aimed to study subjects who failed conventional ventilation. Subject demographics, ventilator parameters, and laboratory data were extracted and analyzed. The Mann-Whitney U-test was used to assess differences in continuous variables, and the chi-square and Fisher exact tests were used for categorical variables between the groups. To assess variables that were predictive of mortality, we used both univariate and multivariate logistic regression analysis. Independent predictors of mortality were identified and used to create a multivariate risk score. Receiver operating characteristic curves were constructed to evaluate the predictive accuracy of the multivariate risk score. RESULTS: A total of 53 premature subjects (n 5 37 male) were studied, of whom 39 (74%) survived to discharge or transfer back to referring hospital. In the univariate model, female sex, older gestational age, higher birthweight, HFJV peak inspiratory pressure at 1 h, and oxygen saturation index at 4 h were associated with mortality. In the final multivariate logistic regression model, female sex (odds ratio 4.1, 95% CI 1.2-19.8, P 5 .044), closed ductus arteriosus (odds ratio 7.7, 95% CI 1.3-39.5, P 5 .016), and oxygen saturation index > 5.5 (odds ratio 6.0, 95% CI 1.5-28.3, P 5 .02) were independent predictors of mortality. CONCLUSIONS: We identified that oxygen saturation index > 5.5 after 4 h of HFJV, female sex, and closed ductus arteriosus were independent predictors of mortality.

BACKGROUND: High-frequency jet ventilation (HFJV) has been used in conjunction with conventional ventilation for infants with respiratory failure. We sought to identify parameters that were associated with successful application of HFJV in patients with hypercapnic respiratory failure. METHODS: A single-center, retrospective review of infants who received HFJV was conducted. Subjects were enrolled if birthweight was <2,000 g and capillary P CO 2 was >55 mm Hg. Ventilator parameters and physiologic data were recorded at 1 h before HFJV initiation and at hours 1, 4, and 6 following conversion. Subjects were classified as responders if capillary P CO 2 was reduced by >10% after 1 h of HFJV. Data included peak inspiratory pressure, PEEP, capillary P CO 2 , and oxygen saturation index (equal to mean airway pressure ؋ F IO 2 ؋ 100/S pO 2 ). Because the data were not normally distributed, they are reported as median (interquartile range), and the Mann-Whitney test was used to assess differences in continuous data between groups. Categorical data were analyzed using a chi-square and Fisher exact test. RESULTS: Thirty-four premature infants (n ‫؍‬ 24 male) were studied. Twenty-five subjects were classified as responders and demonstrated a significant reduction of capillary P CO 2 and F IO 2 and increased pH within the first hour. The non-responders demonstrated a higher conventional ventilation peak inspiratory pressure (25 cm H 2 O vs 19 cm H 2 O, P ‫؍‬ .005) and had a greater postmenstrual age (30 weeks vs 26.5 weeks, P ‫؍‬ .01). This group had a higher oxygen saturation index (7.25 vs 3.36, P ‫؍‬ .03) and F IO 2 requirements (0.6 vs 0.35, P ‫؍‬ .038) at 4 h. CONCLUSIONS: We identified that lower postmenstrual age, improvements in capillary P CO 2 and pH at 1 h, and a reduction of F IO 2 were associated with good response to HFJV. These data may help to identify patients who are likely to benefit from HFJV in the neonatal intensive care unit.