Barotrauma associated with high-frequency jet ventilation for hypoxic salvage
F. W. Clevenger, J. A. Acosta, T. M. Osler, G. B. Demarest and D. E. Fry
Department of Surgery, University of New Mexico School of Medicine, Albuquerque 87131.
Most reports describe reduction in proximal airway pressures with
high-frequency jet ventilation. This led us to speculate that
high-frequency jet ventilation might reduce barotrauma by providing
alveolar ventilation at lower airway pressures. We describe a group of
patients in whom a high incidence of barotrauma was observed after
institution of high-frequency jet ventilation despite reduction in measured
airway pressures. Fifteen hypoxic patients who could not be treated with
conventional ventilation and who had no roentgenographic evidence of
barotrauma were entered into the study. Airway pressures were measured
during conventional ventilation and at 2 and 24 hours after high-frequency
jet ventilation. Despite significant reduction in peak inspiratory and mean
airway pressures, pneumothorax developed in seven of the 15 patients, an
average of 21 hours after initiation of high-frequency jet ventilation.
Five patients had bilateral pneumothorax and three developed tension
pneumothorax. Despite reductions in proximal airway pressures, barotrauma
is a significant potential complication of high-frequency jet ventilation
in patients with noncompliant lungs. We currently place bilateral
prophylactic thoracostomy tubes in patients with adult respiratory distress
syndrome prior to initiation of high-frequency jet ventilation.
