Controlled prospective randomized comparison of high-frequency jet ventilation and conventional ventilation in neonates with respiratory failure and persistent pulmonary hypertension

Abstract

Objective: The objective of this study was to evaluate the efficacy and safety of high-frequency jet ventilation in near-term and term neonates with persistent pulmonary hypertension.

Study design: Subjects for this prospective, randomized, controlled comparison study were recruited from neonates treated in a level-three neonatal intensive care unit that accepts referrals for extracorporeal membrane oxygenation.

Results: In patients treated with high-frequency jet ventilation (n = 11) acute improvement in oxygenation (p = 0.008), ventilation (p < 0.001), and oxygen indices (p < or = 0.01) was demonstrated while stable peak and mean airway pressures were maintained. Control group patients receiving high-frequency positive pressure ventilation with a conventional ventilator required increasingly higher peak inspiratory pressures (p = 0.005) to maintain oxygenation, ventilation, and oxygen indices. There were no significant differences in survival without use of extracorporeal membrane oxygenation, nor were there differences in duration of oxygen therapy, ventilation, and hospitalization; need for extracorporeal membrane oxygenation; or incidence of chronic lung disease.

Conclusions: High-frequency jet ventilation acutely improves oxygenation and ventilation without significantly increasing morbidity. Therefore high-frequency jet ventilation may be a useful adjunct for stabilization of the conditions of neonates with severe persistent pulmonary hypertension. Conclusions about the efficacy of high-frequency jet ventilation in improving survival without the need for extracorporeal membrane oxygenation await multicentered, collaborative investigations with large cohorts of patients.