High Frequency Jet Vent?

Personally, I haven't seen a jet vent since I worked in a NICU in NJ 13 years ago! Since then, I have worked in many institutions across the country & no one else used a jet. I couldn't even begin to know what the difference is; however I have heard the jet is a very old technology & the HFOV is the current way to go. Curious...where do you work (generally, like the state or country)?

Lots and lots of variation by center. At a previous hospital, we got micropreemies on HFOV ASAP, then used HFJV for those who didn't respond well to the oscillator. But once we weaned to a Servo vent, we left them intubated for long periods of time.

At my current unit, we usually start micropreemies on SIMV-PC and focus on early extubation (often within hours). We use HFOV as rescue. Apparently we have access to jets, but I've never seen one used on a neonate there.

Other centers may use HFJV, but they may reserve it for cases of PIE or meconium aspiration. I think one problem is that there may not be a lot of clear and convincing data to prove one ventilatory strategy superior to another.

Deep south Texas. Rio Grande Valley.

Never seen a Jet, only oscillators here but hospitals around us use jets because we get babies from them that had been on jets

I would imagine a big part of why your facility uses the HFJV rather than the HFOV is physician preference. This may be what they learned with and they feel more comfortable using. Also, in healthcare finances play a role so that could be a part of it too. At the NICU's I've worked in I've never seen a HFJV in use, only the HFOV and CMV (conventional mechanical ventilators).

I've never used a jet ventilator but understand that a special ET tube with two extra ports (or an adaptor with the extra ports) is needed. On conventional vents and high frequency oscillator vents we can use the same ET tubes without adaptors.

I've used the SensorMedics 3100A HFOV in the NICUs I've worked in and we mainly use it for air leak syndromes like PIE and Meconium Aspiration Syndrome and for rescue when the conventional vent is not working well enough (usually on small preemies). I understand HFOV is used also for bronchopleural fistula, pre- and post-op congenital diaphragmatic hernia and some forms of pulmonary hypoplasia.

I don't know of a website off the top of my head for you to look for information but I do have two books that I love on the subject:

"Assisted Ventilation of the Neonate"4th Edition by Goldsmith & Karotkin published by Saunders. Dr. Jay Goldsmith is a awesome speaker and plays a very big role in the NRP program. If you ever get to see him at a nursing conference I very highly recommend it. I believe he is affiliated with Tulane and Oschner in New Orleans.

"Neonatal Respiratory Care" 2nd Edition by Donn & Sinha published by Mosby-Elsevier. Dr. Steven Donn is another one of the very big leaders in the neonatal pulmonology field and another terrific speaker...very down to earth and easy to understand. I believe he is with the University in Ann Arbor, MI.

The book by Donn & Sinha is newer (2006) and paperback. The book by Goldsmith & Karotkin is older (2003) and hard bound.

If you find a good website on this subject, please share it with us.

Typically- the Jet is the preferred mode of ventilation for air leak syndrome (PIE for example). It is also preferred over HFOV if hypercarbia is the problem, HFOV being the method of choice if you have problems w/oxygenation as you see w/ meconium aspiration syndrome, PPHN. You can go to the Bunnell website for more information on HFJV. As others have said, it is physician preference. Some neonatal fellows and residents have not trained in centers who use the Jet, so they are less likely to use it as an attending because of comfort level....you have to use it the right way to achieve the effect.

The Bunnell website (they make the jet) has GREAT teaching articles, EBP articles and in-depth explanation on how the Jet vent works. I MAKE my orientees read it. We use the jet quite a bit specially with our tiny babies with air leak problems (PIE).

I highly recommend a google search on "High Frequency Jet" . You'll find what you need and more.

We use both the HFJV and the HFOV in our unit, and we use it for different conditions. As a PP mentioned, HFJV is useful for PIE, and this is most often what we use it for, although we have also had success in using it for MAS. When I first started working here, we did not use the Jet at all, but after having a baby (born at ~24 weeks) with severe PIE who was vent dependent for a LONG time and didn't respond well to other modes of ventilation, we rented a Jet and had the Bunnell people come in and heavily inservice us on its use. He is now a happy 2.5 year old. Since then, we have purchased a Jet and use it when our physicians deem it appropriate. I second the Bunnell website for more information...they have some great resources there!

I checked out the Bunnell website, and the videos they have on there are awesome! Thanks for referring me to them.

In addition to the Bunnell website, the best resource I've found for NICU vent issues is:

http://www.adhb.govt.nz/newborn/teachingresources/ventilation/Ventilation.htm

According to our RT director, NZ is the go to for up to date vent research. They do a great job explaining the basics.

HFJV doesn't require a special ETT. It does require a special adapter for in-line suction.

We use both, though we use HFJV more often than HFOV due to our population. HFOV is used primarily for term kids with PPHN or MAS. We jet the ELBW population who are struggling with tissue compliance - often those tiny guys who have been left in a dry uterus for an extended period and who have failed on a conventional vent. There is some research that connect HFOV to increased IVH in the teeny tinies and we only try it if everything else has failed.

Thanx everyone for the website tip.