Hemodynamic Effects of High-frequency Jet Ventilation in Patients With and Without Circulatory Shock

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Abstract
Nineteen critically ill patients with acute respiratory failure were studied to compare the hemodynamic effects of continuous positive-pressure ventilation (CPPV) and high-frequency jet ventilation (HFJV) at comparable levels of alveolar ventilation. Patients were divided into three groups: Group 1 included seven patients without circulatory shock in whom mean airway pressure .**GRAPHIC**. was slightly higher during CPPV than during HFJV (17.3 .+-. 3.0 vs. 13.0 .+-. 2.9 mmHg); Group 2 inlcuded six patients without circulatory shock in whom HFJV and CPPV were compared at the same level of .**GRAPHIC**. (19.2 .+-. 5.0 mmHg); Group 3 included seven patients with circulatory shock in whom HFJV and CPPV were compared at the same level of .**GRAPHIC**. (16.0 .+-. 3.9 mmHg). The following respiratory frequencies were used in HFJV: Group 1, 200 .+-. 76 beats/min; Group 2, 238 .+-. 103 beats/min; Group 3,286 .+-. 149 beats/min. In all patients comparable levels of PaCO2 were obtained with CPPV and HFJV. In Group 1 patients, mean arterial pressure, cardiac index, and stroke index were significantly higher during HFJV. In Group 2 patients, no significant difference was found between HFJV and CPPV. In Group 3 patients, the following hemodynamic variables were significantly higher during HFJV: mean arterial pressure (71 .+-. 24 vs. 84 .+-. 23 mmHg), cardiac index (3.6 .+-. 1 vs. 4.1 .+-. 1.4 l .cntdot. min-1 .cntdot. m-2), and oxygen delivery (403 .+-. 93 vs. 471 .+-. 124 ml .cntdot. min-1 .cntdot. m-2). However, PaO2 was significantly lower (210 .+-. 105 vs. 155 .+-. 99 mmHg, fractional inspired oxygen content [FIO2] 1) and pulmonary shunt (Qs/Qt) was significantly higher (31 .+-. 12 vs. 36 .+-. 11%) during HFJV. These results demonstrate that patients with circulatory shock and acute respiratory failure have a more favorable hemodynamic profile during HFJV than during CPPV at identical levels of .**GRAPHIC**.

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