HFJV vs. HFOV

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Specializes in NICU.

I'm studying for the CCRN and trying to get a basic grasp of HFJV, as my unit doesn't use it at all. I did a little research and found studies saying that it was capable of adequate ventilation with lower PIP and MAP, contributing to less barotrauma (especially in micropreemies). I asked one of our RTs about it, who said that the oscillator is preferred for its ability to actively pull of CO2 with the vibrating diaphragm, versus the passive exhalation allowed by the jet. He also pointed me to a study that associated HFJV with a high incidence of necrotizing tracheobronchitis and other complications; however, this particular study was published way back in 1984, so I'm wondering if the technology has improved since then.

What's your take on HFJV? For those of you who do use it, what indications/population is it used for; for those who don't, why not?

Thanks!

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Specializes in Neonatal ICU (Cardiothoracic).

Hi!

We are extremely "gentle ventilation" oriented here where I work, so we keep babies (even micros) off the vent if at all possible. When we do have to use HFV, we typically use the oscillator, or high-frequency conventional ventilation. We do use the jet in cases of PIE or MAS, where ball-valve air trapping occurs. Your RT is correct... the oscillator is an excellent "oxygenator".. in that you can use very high MAPs, cycling with tiny tidal volumes, which prevents barotrauma. The jet is a great "ventilator" in that it is a great CO2 removal device. The jet actively pulses gas into the baby's lungs (usually at a rate of 420 or 360) which travels down the center of the tracheal tube. CO2 then spirals up and around that jet of gas, and out of the expiratory circuit passively. In PIE and MAS, you get a lot of gas trapping. The passive exhalation of the jet helps co2 be removed without causing further trapping, which allows the PIE air leak to heal, and prevents overexpanding the baby's lungs with both MAS and PIE.

Jets are not as common as oscillators these days, and require 2 separate vents. They are intimidating to those unfamiliar with them, but very effective when used correctly.

I have heard reports of necrotizing tracheitis, but they are rare, and usually associated with long-term use, and non-ideal ETT placement.

Check out the Bunnell Lifepulse website for more info...

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We use jets but rarely. All the babies I've seen on them have been close to term or term kids and have PIE or PPHN. More often they use for the PPHN and they add nitric. You also have the use the convetional vent along with it to give that big breath every once in a while, but that's all I really know.

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Specializes in NICU.

We use the jet with kids who have PIE, micros up to term kids. Occasionally it's also used if we can't ventilate a kid with the conventional or oscillator. You need a conventional vent also in order to maintain PEEP. I haven't seen any of the necrotizing tracheobronchitis, but I only have 3.5 years of experience.

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Specializes in NICU.
He also pointed me to a study that associated HFJV with a high incidence of necrotizing tracheobronchitis and other complications; however, this particular study was published way back in 1984, so I'm wondering if the technology has improved since then.

When I started in NICU in 1983 we were pioneering jet ventilation with a machine literally built by our RT department. If the study was from 1984, I would consider it too old to be very applicable now. In 6 years we never had a case of tracheobronchitis and although I haven't been around HFJV since the '80s, I'm guessing it's been much improved since then. We used it for the same reasons listed by SteveNNP.

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Specializes in MSN, FNP-BC.

Would someone be kind enough to explain what PIE is?

I know I have heard the term but for the life of me can't remember what it stands for!

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Specializes in NICU.

Pulmonary interstitial emphysema. Air leaks from the alveoli and becomes trapped in the nonventilating lung tissues surrounding blood vessels and lymphatics.

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Specializes in NICU.
Your RT is correct... the oscillator is an excellent "oxygenator".. in that you can use very high MAPs, cycling with tiny tidal volumes, which prevents barotrauma. The jet is a great "ventilator" in that it is a great CO2 removal device.

See, that's what I don't follow, though, because my RT actually said the exact opposite -- that they prefer the oscillator for its ability to ventilate, i.e. actively pull off CO2.

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Specializes in Neonatal ICU (Cardiothoracic).
See, that's what I don't follow, though, because my RT actually said the exact opposite -- that they prefer the oscillator for its ability to ventilate, i.e. actively pull off CO2.

Normally, YES, the oscillator is great at removing CO2. But in PIE and MAS, you have air leaking and trapping, both of which HFOV is less effective at overcoming. The jet is the best at removing Co2 in an air-trapping state. Don't get me wrong, the HFOV can be great in most situations, but in my experience, the jet works wonders with PIE and MAS.

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