HFOV vs Jet

lvnurs9 · Oct 7, 2008

First off, the Jet is NOT an oscillator.

The jet has active inhalation and passive exhalation, just like a conventional vent. It just does it with tiny tidal volumes and a super high rate. This vent is best effective with lung disease such as PIE and is awesome at blowing off CO2.

The oscillator is an oscillator. It is run with a piston that forces air into the lungs and actively pulls it back out. This is considered a rescue ventilator and is used when conventional means is not working. Now adays we use it for micro preemies too, but rescue is the general reason for using it.

Usually when one isn't working, you try the other, but each has its perks.

Preemienurse23 · Oct 8, 2008

I did in error call both an oscillator. They are both High frequency vents. One has a piston, and the other doesn't. One pulls/pushes the air, the other pushes it down the center and and the the CO2 is swirled out on the outside of the tube. How they work was not the question., I understand that. I was wondering if there was a preference. If units out here used the jet on a regular basis vs a last choice vent.

lvnurs9 · Oct 8, 2008

I have only worked in 2 hospitals, but from what I have heard, many places only use the oscillator.

For those that use both, like I mentioned before, it's a matter of what is wrong with the baby. They work very differently, so it is usually not a matter of preference.

As far as working with them, as a nurse, I like the Jet because the tubing is flexible like a conventional. I hate nothing more then a 500 grammer on an oscillator... that tubing is so heavy...

PICNICRN, BSN, RN · Oct 8, 2008

Oscillation works better for kiddos with poor oxygenation/ Jet is better for those who need to blow off more CO2. IMO both work great when used for what they were meant for. As for the oscillator, in my experience, kiddos do so much better when started early(not waiting until thier lungs are so sick- its the last ditch effort) this vent can do wonders for preventing barotrauma before it is too late. Many times babies with severe RDS start out on the oscillator and wean to conventional vent as compliance improves- it is really not supposed to be used as a last resort(although many times you will see it used this way).

RN4Little1s · Oct 8, 2008

Seems like we only use HFOV as a last resort... and sometimes it works. You'll hear - oh, they made it? and they were on the oscillator?

I've never heard of the jet.

SteveNNP, MSN, NP · Oct 8, 2008

Oscillation works better for kiddos with poor oxygenation/ Jet is better for those who need to blow off more CO2. IMO both work great when used for what they were meant for. As for the oscillator, in my experience, kiddos do so much better when started early(not waiting until thier lungs are so sick- its the last ditch effort) this vent can do wonders for preventing barotrauma before it is too late. Many times babies with severe RDS start out on the oscillator and wean to conventional vent as compliance improves- it is really not supposed to be used as a last resort(although many times you will see it used this way).

Exactly..... many places reserve it as a last resort... I came from a unit that used it as a first-line vent for preemies requiring ventilation, and saw a huge decrease in the number of BPD cases... I

UTVOL3 · Oct 8, 2008

Hey this is kind of a thread jack, feel free to move it if you want, but...

What do you do about turning your kids on HFO? We used to flip them kind of "end-over-end" especially the little ones, they don't like us to disconnect from the vent even for a sec especially with the HFO. Then they started not wanting us to do that, saying it would increase the risk of IVH when the kid was flipped. Obviously I am not talking about flipping them fast, we took it very sloooowww. but still a concern. I just wonder what every one else does.

Preemienurse23 · Oct 8, 2008

We start with the CMV with most of the kids, usually the little ones are started onthe HPOV and the Jet is our last resort. I was kind of in a panic mode when we put my little one on the Jet, I had not used it since my internship, well over a year ago.

As for flipping them, We start to flip them after 3days I think, starting with once a day, then to q12. We do breifly disconnect them. Usually there is an RT helping or very close by.

lvnurs9 · Oct 13, 2008

You leave a baby in the same position for 3 days?? We are HUGE on developmental positioning. We "tilt" them differently with each set of cares, and rotate them every 12-24 hours depending on the situation.

lvnurs9 · Oct 13, 2008

We were always good about using HFV when it was warranted before things got out of hand. We also started using it as a first line for micros. We have actually decreased our number of head bleeds. Haven't seen a bad one in a while, with the exception of one I don't want to talk about :)

I think the importance lies in positioning. Micros need to keep a midline position as laying their head completely to one side could occlude their vessels. We are just vigilant in positioning...

SteveNNP, MSN, NP · Oct 14, 2008

Any increase in the number/severity of head bleeds at your old unit? My unit uses oscillators as last resort with the rationale that they can prevent head some head bleeds. However, it seems like most of our micros have some kind of head bleed anyway and then get at least one round of steroids when they get BPD 1-2 mo later...I've noticed an awful lot of tongue thrusting lately when they are big and almost ready to go home

Nope.... we actually developed an IVH prevention protocol, involving minimal stim, appropriate pain management, among other things, and saw our IVH drop from 18% in

We weaned from HFOV to NC/Vapotherm. Our BPD rate was around 10%.... pretty low. I've only had to give steroids once, and it was for a kid who needed to get off the vent after being on for 3 months.