Respiratory Care Services, Duke University Medical Center, Durham, North Carolina.
Division of Pediatric Critical Care Medicine, Duke Children's Hospital, Durham, North Carolina.
Respir Care. 2021 Feb;66(2):191-198. doi: 10.4187/respcare.08241. Epub 2020 Oct 2.
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.
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.
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), [Formula: see text] = 133 (91.3-190.0), pH = 7.18 (7.11-7.27), [Formula: see text] = 64 (52-87) mm Hg, and [Formula: see text] = 74 (64-125) mm Hg. For subjects still on HFJV ( = 25), there was no significant change in OI, [Formula: see text], or [Formula: see text] at 4-6 h after initiation, whereas pH increased ( = .001) and [Formula: see text] decreased ( = .001). For those remaining on HFJV for > 72 h ( = 12), the linear effects model revealed no differences over 72 h for OI, [Formula: see text], [Formula: see text], or mean airway pressure, but there was a decrease in [Formula: see text] while pH and [Formula: see text] increased. There were 9 (26%) subjects who did not survive, and nonsurvivors had higher Pediatric Index of Mortality 2 scores ( = .01), were more likely to be immunocompromised ( = .01), were less likely to have a documented infection ( = .02), and had lower airway resistance ( = .02).
HFJV was associated with improved ventilation among subjects able to remain on HFJV but had no significant effect on oxygenation.
高频喷射通气（HFJV）主要用于早产儿；然而，已有关于其在患有急性呼吸衰竭的儿科患者中的应用的报道。本研究的目的是评估 HFJV 在儿科重症监护病房的应用。我们假设 HFJV 将与氧合和通气的改善相关。
回顾性分析了 2014 年至 2018 年间在一家四级保健中心的儿科重症监护病房接受 HFJV 的所有患者的病历。排除未出院的早产儿和在体外膜氧合时开始接受 HFJV 的患者。使用卡方检验对分类变量、非参数检验对连续变量和线性效应模型进行分析，以评估时间上的气体交换。
共纳入 35 例患者（中位年龄=2.9 个月，中位体重=5.2kg）。在开始 HFJV 之前，氧合指数（OI）中位数（四分位距）为 11.3（7.2-16.9），[Formula: see text]为 133（91.3-190.0），pH 值为 7.18（7.11-7.27），[Formula: see text]为 64（52-87）mmHg，[Formula: see text]为 74（64-125）mmHg。对于仍在接受 HFJV 治疗的 25 例患者，在开始治疗后 4-6 小时，OI、[Formula: see text]或[Formula: see text]均无显著变化，而 pH 值升高（=.001），[Formula: see text]降低（=.001）。对于在 72 小时以上仍在接受 HFJV 治疗的 12 例患者，72 小时内，OI、[Formula: see text]、[Formula: see text]或平均气道压力无差异，但[Formula: see text]下降，而 pH 值和[Formula: see text]升高。9 例（26%）患者未存活，未存活者的儿科死亡风险 2 评分较高（=.01），免疫功能低下的可能性较大（=.01），有记录的感染可能性较小（=.02），气道阻力较低（=.02）。
HFJV 可改善能继续接受 HFJV 治疗的患者的通气，但对氧合无显著影响。
