Response to high frequency jet ventilation may predict the need for extracorporeal membrane oxygenation

Abstract

The aim of this study was to determine predictors of response whilst using high frequency jet ventilation (HFJV) for infants in intractable respiratory failure, in order to avoid the utilization of extracorporeal membrane oxygenation (ECMO). We reviewed patient demographics, ventilator parameters, blood gas values, length of oxygen therapy and use of surfactant and outcome, in infants given a 4 h trial of HFJV as the minimum to eliminate those infants where HFJV is used as a bridge to ECMO. The study was carried out in the neonatal intensive care nursery at Kosair Children's Hospital in Louisville, Kentucky, which provides high frequency ventilation and ECMO. Thirty infants who were eligible for ECMO and who met the study criteria were divided into two groups based upon response to HFJV. Twenty two infants responded to HFJV and eight nonresponders required ECMO after a trial of HFJV. Infants responding during HFJV demonstrated a significant decrease in oxygenation index without an escalation of mean airway pressure within 4 h after the initiation of HFJV. These infants had lower birth weights and an increased incidence of respiratory distress syndrome. No statistical differences were found in length of ventilation, days of oxygen therapy or duration of HFJV between the groups. Infants in intractable respiratory failure, who are eligible for extracorporeal membrane oxygenation, should receive a trial of high frequency jet ventilation, especially if the cause is respiratory distress syndrome unresponsive to surfactant therapy. During high frequency jet ventilation, the oxygenation index and mean airway pressure should be monitored serially, since they may predict the need for extracorporeal membrane oxygenation.

Assessing Initial Response to High-Frequency Jet Ventilation in Premature Infants With Hypercapnic Respiratory Failure

“…Additionally, F IO 2 was significantly higher for non-responders during this time, at similar ventilating pressures, which may suggest that these subjects may have benefited from increased PEEP. Furthermore, these findings may suggest that subjects failing HFJV had a more significant oxygenation derangement and are in accordance with those of Stewart et al 15 These authors found that responders to HFJV were characterized by a decrease in oxygenation index at hour 4 (10.7 Ϯ 5.2) compared with (17.6 Ϯ 13.4) in non-responders, without an increase in P aw . Similarly, Baumgart et al 13 reviewed 73 extracorporeal membrane oxygenation-eligible infants of Ͼ34 weeks gestational age who received HFJV secondary to intractable respiratory failure.…”

“…[13][14][15] In the current study, capillary P CO 2 and pH were studied considering that the majority of subjects (n ϭ 29, 85%) did not have arterial access when HFJV was initiated. A significant reduction in capillary P CO 2 and elevation of pH were observed in the responder group following 1 h of HFJV.…”

Safety and efficacy of high-frequency jet ventilation in neonatal transport

“…13 Likewise, HFJV has also been found to be very effective in improving oxygenation and ventilation of in pre-ECMO neonates. 5 While HFJV appeared to be better at improving oxygenation and efficiency in gas exchanges than the use of CMV, either immediately after changing ventilator to an HFJV (Table 3) or after the transported neonates reached our unit (Table 2), the values did not reach statistical significance. The iNO-to-CMV connection in our setup instead of the iNO-to-HFJV depends on the ability of the jet flow to entrain gas from the conventional limb.…”

“…2 The use of iNO or a high-frequency ventilator has been shown to decrease the need for ECMO, [3][4][5] but consequently, also increases the need to promptly transport nonresponders with the same combination of high-frequency ventilation and iNO to an ECMO center.…”

High-frequency jet ventilation in European and North American institutions: developments and clinical practice

“…First, HFJV was used as a special ventilation mode during diagnostic or surgical procedures in patients with airway pathology [2±5,20±22]. Second, HFJV was employed as a respiratory support technique to improve gas exchange during severe pulmonary failure (Table 1) in infants, children and adults (47%) [7±11, 23,24]. Furthermore, hand-triggered jet ventilation devices served as emergency tools to manage dif®cult airways (`can't intubate, can't ventilate' situations) with intravenous (i.v.)…”