WHEN and HOW do we use the NEONATAL High Frequency Jet Ventilator!!!

PART II on jets!! WHEN do we USE the jet ventilator? What settings do we START babies on? What settings do we change if the gas shows an elevated C02? What about if we have a pneumothorax? What if the baby's oxygen is dropping? Should we always be using the jet for tiny premature infants? What evidence do we have? Learn the answers to all these questions in this video! PART II of our JET series.

A massive THANKS to Bunnell (https://bunl.com/) for helping us with so many educational materials for this video (and especially to Kari Neville BSRC, RRT-NPS, FAARC who couldn't have been more responsive and helpful!)
This video was NOT sponsored.
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Dr. Tala is a board-certified neonatologist and has worked in busy level III and IV units for the past 15 years. She has won multiple teaching awards throughout her time as a neonatologist.
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References:
Rallis D, Ben-David D, Woo K, Robinson J, Beadles D, Bernardini L, Abdulhayoglu E, Flanigan E, Christou H. Single center experience with first-intention high-frequency jet vs. volume-targeted ventilation in extremely preterm neonates. Front Pediatr. 2024 Jan 4;11:1326668. doi: 10.3389/fped.2023.1326668. PMID: 38239592; PMCID: PMC10794594.

Sindelar R, Nakanishi H, Stanford AH, Colaizy TT, Klein JM. Respiratory management for extremely premature infants born at 22 to 23 weeks of gestation in proactive centers in Sweden, Japan, and USA. Semin Perinatol. (2022) 46:151540. 10.1016/j.semperi.2021.151540 - DOI - PubMed

Elgin TG, Stanford AH, Klein JM. First intention high-frequency jet ventilation for periviable infants. Curr Opin Pediatr. (2022) 34:165–9. 10.1097/MOP.0000000000001104

Ganguly A, Makkar A, Sekar K. Volume targeted ventilation and high frequency ventilation as the primary modes of respiratory support for ELBW babies: what does the evidence say? Front Pediatr. (2020) 8:27. 10.3389/fped.2020.00027

Rojas-Reyes MX, Orrego-Rojas PA. Rescue high-frequency jet ventilation versus conventional ventilation for severe pulmonary dysfunction in preterm infants. Cochrane Database Syst Rev. (2015) 2015:CD000437. 10.1002/14651858.CD000437.pub3

Collins JJP, Tibboel D, de Kleer IM, Reiss IKM, Rottier RJ. The Future of Bronchopulmonary Dysplasia: Emerging Pathophysiological Concepts and Potential New Avenues of Treatment. Front Med (Lausanne). 2017 May 22;4:61. doi: 10.3389/fmed.2017.00061. PMID: 28589122; PMCID: PMC5439211.

Söderström F, Normann E, Jonsson M, Ågren J. Outcomes of a uniformly active approach to infants born at 22-24 weeks of gestation. Arch Dis Child Fetal Neonatal Ed. 2021 Jul;106(4):413-417. doi: 10.1136/archdischild-2020-320486. Epub 2021 Jan 15. PMID: 33452221.

Yanagisawa T, Nakamura T, Kokubo M. Prognosis of 22- and 23-Gestational-Week-Old Infants at Our Facility: A Retrospective Cohort Study. Am J Perinatol. 2022 Mar 11. doi: 10.1055/a-1779-4032. Epub ahead of print. PMID: 35193151.

Watkins PL, Dagle JM, Bell EF, Colaizy TT. Outcomes at 18 to 22 Months of Corrected Age for Infants Born at 22 to 25 Weeks of Gestation in a Center Practicing Active Management. J Pediatr. 2020 Feb;217:52-58.e1. doi: 10.1016/j.jpeds.2019.08.028. Epub 2019 Oct 9. PMID: 31606151.

Respiratory Distress Syndrome of the Newborn Infant - Scientific Figure on ResearchGate. Available from: https://www.researchgate.net/figure/C...


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**TIMESTAMPS**
00:45 When do we use the jet?
05:47 Initial Settings using a jet ventilator
10:58 How to titrate jet based on clinical scenarios
11:21 How to titrate jet when CO2 too high
14:38 How to titrate jet when nfant hypoxemic
16:06 How to titrate jet when infant has a high C02 and lungs are HYPER-expanded
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*Disclaimer*: This video is intended for educational purposes only and while
we strive to give the most accurate information, errors may occur. Subsequently,
this video should not be a replacement for medical advice.