HFOV vs Jet

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When it comes to the oscillators, which vent do you prefer/like better the high frequency or the jet. I know they are both oscillators, but the way they work are different. I've been caring for my first baby on the Jet and so far I seem to like it better than the HFOV even though it takes up more room. Just wondering.

We dont leave them in one positon for seveal days. We reposition them, back, side, tummy. We now are using a blue connector peice on our HPOVs that allow us to be able to turn them any direction without disconnecting them. Previously we would wait until they stabilized and then begin to head to toe filp them q24, q12 and then q8. It depends on the kid too. We position for development, but if they dont tolerate it, we move them as little as possible.

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Specializes in NICU Level III.

It seems like we admit on the HFOV and go to the jet within 24 hrs or so. I think our MDs prefer the jet.. I do because I'm more familiar with it and the tubing is less bulky.

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Specializes in NICU, PICU, educator.

We don't use jet, we only oscillate. I wish we started these tiny ones on the osc at first, but it seems that our docs like to wait until their co2s are nice and high and then they put them on it. We had one attending that admitted to osc and weaned off to NC from osc...those kids did great!

We used the very first jets that were out almost 20 years ago....they were eventually recalled by the FDA because you knew as soon as they brought that out, your kid would die. They all blew numerous pneumos on the behemoth! We also had to reintubate them with a special tube for the jet and it was considerably larger than the one they had in. So if they survived that , then they would have a minimum of 2 chest tubes and then die in a few days. It was awful.

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We used the very first jets that were out almost 20 years ago....they were eventually recalled by the FDA because you knew as soon as they brought that out, your kid would die. They all blew numerous pneumos on the behemoth! We also had to reintubate them with a special tube for the jet and it was considerably larger than the one they had in. So if they survived that , then they would have a minimum of 2 chest tubes and then die in a few days. It was awful.

Wow! Fortunately we don't see a lot of chest tubes. But we do go through those periods where it seems everyone has one!

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Specializes in NICU.

We too use the HFOV more as a rescue vent. There are some kids who are so sick down in the DR that they do go straight to the HFOV (our DH kids always do).

Fortunately for us - our docs always use a volume guarantee setting for the micros when they are first born and are on the regular vent. There is a set volume needed for each breath (based on their weight, lung compliance...) and the PIP needed for each breath will vary depending on what pressure they need to reach that volume. It's worked really well in reducing our need for chest tubes on the micros.

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Specializes in NICU.
Wow! Fortunately we don't see a lot of chest tubes. But we do go through those periods where it seems everyone has one!

We got trips the other day, by shift's end all three had 'em, and two were still on CPAP.

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Specializes in NICU.

We are using a Jet for the first time, and we use the oscillator relatively often. The baby we are using the Jet on has PIE, is about eight weeks old, and failed other forms of ventilation, so we had a Jet brought in. He was a 24 weeker, so it was sort of a last-ditch effort to help him get better.

For the most part, the things I like about the Jet are that the tubing is like a regular vent, that the vent is not as loud (we have an open floorplan, so an oscillator makes the whole NICU noisy), and that it seems to be working for him. I don't like that I don't know everything there is to know about it...I find it difficult to decide if the fluctuations in the readings are something to worry about or just the nature of the Jet doing its work.

As for flipping kids on HFOV, we flip end over end every 24 hours. I believe that they are briefly disconnected when that happens. We also weigh and change bedding at this time. However, this all happens on day shift, and I work nights, so I have never actually seen it happen.

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We got trips the other day, by shift's end all three had 'em, and two were still on CPAP.

They had CT's and still on CPAP? Wow. I havent seen that yet. We either vent, put on a NC or have on O2 support.

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We dont leave them in one positon for seveal days. We reposition them, back, side, tummy. We now are using a blue connector peice on our HPOVs that allow us to be able to turn them any direction without disconnecting them. Previously we would wait until they stabilized and then begin to head to toe filp them q24, q12 and then q8. It depends on the kid too. We position for development, but if they dont tolerate it, we move them as little as possible.

Yeah, I love that blue piece, makes repositioning so much easier.

I'm going to thread jack here a bit. What are your policies for paralysis while on HFOV? My understanding is that it used to be the norm, but now its less popular? My little buddy on HFOV last week really needed it, and I had to advocate hard to get it. Surprise, surprise, went from 7.09/80s to 7.33/50s withing an hour, and stayed that way for several hours. Part of the issue is that he has some musculoskeletal deformities that make it hard to tell when he is "agitated"...three nights of caring for him 1-1 taught me to recognize the very subtle physical movements (correlated with VS changes and gasses) that indicated agitation.

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Specializes in NICU.

Pssh. I'm lucky to get prn orders for Versed or Ativan if I've got a kid on HFOV. I'm sure you're all shocked. Paralysis is ONLY for kids with open sternums after cardiac surgery, and even that we're moving away from a little bit. The kids are now allowed to be awake enough to move extremities, just as long as they're not bucking the vent.

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Specializes in NICU, adult med-tele.

We use paralysis very infrequently as well. One thing I wish we saw more of was Ativan. It seemed to reallly help the couple kiddos I've used it with.

Fentanyl is our drug of choice, followed by versed.

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Specializes in NICU.

We (almost) always have fentanyl drips for the babies on the HFOV. They get started at 1mcg/kg/hr and then will go up from there. We also always have prn doses (usually 1-2mcg/kg every 2h prn) ordered as well.

When our kiddos are sick enough to be on the HFOV, our docs don't want them moving around / being all agitated.

Back to the original thread -

We will will rotate the kids (180 degrees around) every 12 hours or so - as long as they are stable enough to do so. We coordinate it w/ VS, and weighing / linen changes and all that stuff. Our docs always let us know if they don't want them rotated or anything like that.

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