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High‐frequency jet ventilation in children with the adult respiratory distress syndrome complicated by pulmonary barotrauma
Author(s) -
Smith David W.,
Frankel Lorry R.,
Derish Melinda T.,
Moody Robert R.,
Black Lehman E.,
Chipps Bradley E.,
Mathers Lawrence H.
Publication year - 1993
Publication title -
pediatric pulmonology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.866
H-Index - 106
eISSN - 1099-0496
pISSN - 8755-6863
DOI - 10.1002/ppul.1950150504
Subject(s) - medicine , respiratory distress , ventilation (architecture) , high frequency ventilation , jet ventilation , respiratory disease , respiratory system , pediatrics , intensive care medicine , mechanical ventilation , anesthesia , lung , airway , mechanical engineering , engineering
High‐frequency jet ventilation (HFJV) was used in 29 children with severe ARDS complicated by pulmonary barotrauma (PST). Treatment with HFJV was begun when PBT was progressing over a 24‐h period while receiving conventional ventilation (CV). The mean (±SD) age was 0.95 ± 1.21 years (range, 0.03‐4 years). The most common diagnosis was viral pneumonia (n = 17); other diagnoses included aspiration pneumonitis (n = 4), bacterial pneumonia (n = 3), multiple trauma (n = 2), and near‐drowning (n = 3). The Bunnell Life‐Pulse ventilator was used at a rate of 240/min or 300/min, with inspiratory time of 0.02 sec. Twenty children survived (69%). Survivors and nonsurvivors had equal disease severity prior to HFJV as assessed by ventilator settings, alveolar‐to‐arterial oxygen tension gradient, oxygenation index, and blood gas values. Survivors had spent significantly less time on conventional ventilation prior to HFJV than nonsurvivors, with a mean (±SD) of 3.7 ± 2.1 days vs 9.6 5 4.5 days, respectively (P < 0.05). Survivors underwent an average of 4.4 ± 3.9 days of HFJV, which supported adequate gas exchange with lower airway pressures, and produced resolution or significant improvement in airleak on chest radiograph. In conclusion, we speculate that the application of HFJV early in the course of severe hypoxemic respiratory failure complicated by airleak, allows the reduction of airway pressures, thereby minimizing pulmonary barotrauma and allowing the lung to recover from the underlying insult. Further controlled evaluation of HFJV in this high risk group of patients is warranted. © 1993 Wiley‐Liss, Inc.