HIGH FREQUENCY JET VENTILATION TREATMENT OF PULMONARY INTERSTITIAL EMPHYSEMA

Abstract

Twenty-two neonates with pulmonary interstitial emphysema (PIE) unresponsive to conventional forms of treatment, were ventilated with a high frequency jet ventilator (HFJV). Sixteen of 22 developed PIE subsequent to severe hyaline membrane disease (HMD), 5 were in association with bacterial pneumonia-septicemia, and 1 was associated with meconium aspiration syndrome. All but 1 patient (septicemia) showed temporary or permanent resolution of the PIE; however only 11 (50%) survived. The 16 patients with HMD-associated PIE had the most favorable outcome. In that group, switching from intermittent mandatory ventilation (IMV) to HFJV resulted in a mean drop in PaCO2 from 60 mmHg (range 29-192) to 37 mmHg (range 13-53) while operating at an intratracheal mean airway pressure (MAP) of 3.1 cm H2O less (0.3-7.6) and a peak inspiratory pressure (PIP) of 9 cmH2O less (2-15) than on IMV. Of the 11 patients who died, 7 (64%) had pulmonary bacterial infection, either during life (n=3) or at postmortem (n=4). Factors significantly favoring survival included (1) lack of bacterial infection, (2) development of PIE after 48 hours of age, and (3) a drop of PaCO2 of over 30 mmHg on HFJV while maintaining a constant PaO2 using lower PIP and MAP than was required on IMV. We conclude that HFJV is effective in resolving PIE and improving survival in neonates with HMD-associated PIE.

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