Contemporary Indications for High-Frequency Jet Ventilation in Infants and Small Children

Background: High-frequency jet ventilation (HFJV) was approved by the FDA in 1988 for the treatment of respiratory distress syndrome (RDS) complicated by pulmonary air leaks. Evidence supporting HFJV in preterm infants with RDS stems from trials conducted decades ago. Therefore, we sought to update this historical experience by describing contemporary applications of HFJV among infants and small children with the aim of benchmarking HFJV parameters and outcomes. Methods: After obtaining IRB approval, we conducted a retrospective study of subjects who underwent HFJV at Boston Children’s Hospital between 2012 and 2022. All subjects who received HFJV for the first time were included for analysis. Exclusion criteria were extracorporeal membrane oxygenation (ECMO) prior to HFJV and records with incomplete data. Serial evaluation of ventilator parameters and physiologic variables were extracted from the medical record during 5 epochs: prior to HFJV, 4 h, 6 h, 12 h, and 48 h following conversion to HFJV. Descriptive statistics were calculated for variables. Continuous variables were expressed as mean ± standard deviation or median interquartile range as appropriate. Results: We identified 331 subjects (median PMA 32.5 weeks, 1.7 kg) who underwent HFJV, primarily for RDS of prematurity (n = 183, 58%) including 69 (20%) with air leak syndrome (Table 1). Other underlying diagnoses included congenital heart disease (n = 50, 16%) and meconium aspiration syndrome (n = 29, 10%). Comorbid conditions were common, including PDA closure (n = 59, 19%) and necrotizing enterocolitis or spontaneous intestinal perforation (n = 58, 19%). Mode of ventilation prior to HFJV included conventional ventilation (78%), HFOV (8%) and (13%) went on HFJV at admission. Clinical characteristics, ventilator settings and gas exchange data from HFJV initiation through 48 h are presented in (Table 2). On average (± SD), patients improved by 1 h (compared to prior mode of ventilation) in pH (7.14 ± 0.13 vs. 7.26 ± 0.14), PCO2 (75 ± 22 vs. 56 ± 21), and PaO2 (67 ± 37 vs. 81 ± 60). Of the 238 survivors, 51% were discharged on NIV, 9% conventional ventilation, 20% nasal cannula, and 9% had no respiratory support. Conclusions: While HFJV is still primarily used for infants with RDS of prematurity, only 20% of patients had air leak syndrome. Indications for HFJV have expanded to include a wide range of both medical and surgical underlying pathologies. These data provide useful contemporary benchmarks for the use of HFJV.