Proximal high-frequency jet ventilation of the newborn.

During a 14-month period 11 preterm infants were treated with high-frequency jet ventilation for severe respiratory failure that had been unresponsive to conventional mechanical ventilation. Primary indications included intractable air leaks (pulmonary interstitial emphysema, pneumothorax, or both), congenital diaphragmatic hernia, and progressive pneumonia. The Sechrist 990 HFV respirator, a solenoid-driven, pulse-generated high frequency jet ventilator, was used. This device delivers a volume of gas at a controlled pressure to a jet located in the patient connector proximal to a standard single lumen endotracheal tube. The ventilator was operated in tandem with a Sechrist IV-100B ventilator to provide a sigh effect and to improve humidification. Although only 3 of 11 patients survived, 9 displayed short-term benefits from HFJV with significant reduction in mean airway pressure and improvement in mean arterial blood pressure, and no concomitant adverse effects on oxygenation or ventilation. Preliminary results suggest short-term benefits of HFJV in infants who have severe respiratory failure that is unresponsive to conventional mechanical ventilation.