High frequency jet ventilation safe ventilation strategy for congenital diaphragmatic hernia

A recent study published in the Journal of Pediatric Surgery found High frequency jet ventilation (HFJV) as an effective ventilation strategy for congenital diaphragmatic hernia (CDH). 

Congenital diaphragmatic hernia is a condition that can cause severe respiratory distress in newborns. High frequency jet ventilation is a ventilatory mode that has been used as both a rescue therapy and primary ventilation strategy in CDH management. This study aimed to describe the experience of a single institution in using HFJV for CDH stabilization and to compare outcomes between different ventilation modes.

The study included a review of liveborn CDH patients treated from 2013 to 2021 at a single institution, and the patients were divided into three groups based on their primary and last ventilation mode prior to surgery: CMV (Group 1), HFJV (Group 2), and CMV/HFJV (Group 3).

The researchers found that patients in Group 2 and 3 had more severe disease compared to those in Group 1, based on various factors such as liver position, SNAP-II score, pulmonary hypertension severity, need for inotropic support, CDHSG defect size, and need for patch repair.

In terms of outcomes, there were no significant group differences in survival, need for extracorporeal membrane oxygenation (ECMO), or pneumothorax occurrence, although infants receiving HFJV required longer invasive ventilation and had a greater need for oxygen at discharge.

Multivariate logistic regression did not reveal any significant associations between the mode of ventilation and outcomes. Therefore, the study suggests that HFJV is an effective ventilatory mode for both CMV rescue and as a primary ventilation strategy in high-risk CDH cases. However, longer ventilation duration and higher oxygen requirement may be expected with HFJV.

Source:

Al Kharusi, A., Al-Maawali, A., Traynor, M., Adreak, N., Ting, J., & Skarsgard, E. D. (2023). High frequency jet ventilation for congenital diaphragmatic hernia. In Journal of Pediatric Surgery. Elsevier BV. https://doi.org/10.1016/j.jpedsurg.2023.01.026