1. Outcomes in Neonates with Hypoxemic Refractory Respiratory Failure on High-Frequency Oscillatory Ventilator versus High-Frequency Jet Ventilator
Alla Kushnir MD, Jane Chung MD, Judy Saslow MD, Linda Slater-Myer MD,
Soumini Chintala MD, Janani Sankaran MBBS
Department of Pediatrics, Cooper University Hospital, Camden, NJ
Baseline Characteristics
Mean Fraction of Inspired Oxygen
during the 1st week
Results
Total of 58 preterm infants from 1/1/2008 to 2/2016 were evaluated, 27 that were changed to HFJV and 31 were only treated with HFOV.
There were no significant differences in gestational age, birth weight, gender, or race between the groups.
There was no difference in LOS or rate of BPD between the groups.
There was a significantly lower rate of severe ROP (p<0.03) in those who were changed to HFJV.
There was an increased rate of pneumonia in those who were changed to HFJV.
There was a significantly lower requirement for post-natal steroids (p=0.003) in neonates who were changed to HFJV.
Median postnatal age at change to the HFJV was 18 days and patients remained on the Jet ventilator for an average of 12 days.
Introduction
Extremely preterm infants often develop hypoxemic refractory respiratory failure (HRRF) and chronic lung disease (CLD). High-frequency oscillatory ventilation (HFOV) and high frequency jet ventilation (HFJV) have become the standard of care for supporting patients with respiratory failure in neonatal intensive care units. HFJV delivers small tidal volumes in a very short inspiratory time at high rates, which may improve airway patency and lead to better gas distribution and improve gas exchange. It may provide superior alveolar ventilation and oxygenation compared with other ventilatory modes. Friedlich determined that the use of HFJV improved hypoxemic respiratory failure unresponsive to HFOV in very immature infants in whom evolving CLD was complicated by pneumonia or sepsis. An improvement in oxygenation has been seen in the first week after change from HFOV to the HFJV in our previous study.
HFOV only
N=31
HFOV to HFJV
N=27 p
Gender, %
Males 61 70
0.47
Race, %
0.5
Birth weight, grams
661
738
0.16
Gestational Age, weeks
24.8
25.1
Data on the
day of HRRF
Day of life 14 24
0.11
MAP
13.5
14.9
0.08
FiO2
91.5
93.4
0.6 OI 30
42.6
0.06
Clinical Outcomes
HFOV only
N=31
HFOV to HFJV
N=27 p
BPD, n (%)
18 (58)
17 (63)
0.7
Severe IVH, n (%)
3 (14)
6 (23)
0.45
PVL, n (%)
2 (12)
6 (22)
0.38
NEC, n (%)
5 (24)
5 (19)
0.66
Severe ROP, n (%)
13 (76)
9 (43)
0.03*
Sepsis, n (%)
18 (72)
16 (59)
0.39
Pneumonia
1 (6)
15 (56)
0.001*
Length of stay, days
88.6
81.6
0.62
Death, n (%)
9(30)
11 (41)
0.4
Objective
To evaluate short term outcomes in neonates with HRRF, who were switched to HFJV or continued on HFOV.
Mean Airway Pressure when Changed from HFOV to HFJV and during 1st Week
Conclusions
There was no difference in death, BPD or LOS noted for those changed from HFOV to HFJV, however, there was a decrease in ROP noted. There was lower use of steroids in the HFJV group. This might imply a decrease in BPD or other respiratory outcomes if examined in a larger sample.
Methods
IRB approved prospective observational and retrospective data analysis from 1/1/2008 to 2/2016 .
Babies switched to HFJV due to HRRF were compared to age matched controls from the era prior to the use of HFJV in our NICU.
Hypoxic respiratory failure defined as OI of > 20 or oxygen requirement >60 % with MAP providing optimum lung expansion on HFOV.
Primary outcomes: difference in length of stay (LOS) and development of bronchopulmonary dysplasia (BPD) between the two groups.
Secondary outcomes: differences in duration of ventilatory support, use of diuretics and post-natal steroids compared between groups.
Respiratory Outcomes
HFOV only
N= 31
HFOV to HFJV
N=27 p
Days ventilated 62
60.6
0.9
Days on respiratory support 81 84
0.83
Days on HFV 19 12
0.18
BPD, n (%)
18 (58)
17 (63)
0.7
Rate of diuretic use, n (%)
15 (79)
21 (78)
0.92
Rate of postnatal steroid use (Hctz, Dex, Pred), n (%)
19 (95)
15 (56)
0.003*
References
1. Cotten M, Clark RH. The science of neonatal high-frequency ventilation. Respiratory care clinics of North America 2001;7(4):
2. Bass AL, Gentile MA, Heinz JP, Craig DM, Hamel DS, Cheifetz IM. Setting positive end- expiratory pressure during jet ventilation to replicate the mean airway pressure of oscillatory ventilation. Respiratory care 2007;52(1):50-5.
3. Courtney SE, Durand DJ, Asselin JM, Hudak ML, Aschner JL, Shoemaker CT. High- frequency oscillatory ventilation versus conventional mechanical ventilation for very-low- birth-weight infants. The New England journal of medicine 2002;347(9):
4. Friedlich P, Subramanian N, Sebald M, Noori S, Seri I. Use of high-frequency jet ventilation in neonates with hypoxemia refractory to high-frequency oscillatory ventilation. J Matern Fetal Neonatal Med 2003;13(6):
* p<0.05