The tracheobronchial histopathologic findings in eight neonates who died after treatment with high-frequency jet ventilation (HFJV) were compared with those in eight similar infants who died after treatment with conventional mechanical ventilation. The HFJV and conventionally treated groups were matched as closely as possible for birth weight, gestational age, and duration of mechanical ventilation. A 4-point, nine-variable histologic scoring system was used to grade tissue changes in the trachea, carina, and mainstem bronchi. The patients who received HFJV had significantly more histologic damage in their tracheas, carinas, and right and left mainstem bronchi. At all levels of the airway examined, HFJV was associated with more inflammation, greater losses of ciliated epithelium, and more mucus within the lumen of the airway than was conventional mechanical ventilation.
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High-frequency jet ventilation has been used successfully in a variety of adult and neonatal lung disorders, 1-5 and appears to be most useful in the treatment of seemingly intractable pulmonary air leaks. It was recently called the treatment of choice for recalcitrant airway disruptions in adults. 6 However, several clinical reports and two recent animal studies have linked HFJV to unusual tracheal injuries, 1,3'7d~ particularly forms of necrotizing tracheobronchitis. In a few instances, these were fatal. The Supported by grants from the 3M Company, Bunnell Inc., the Research and Education Fund of Children's Hospital of St. Paul, and Mr. William Holcomb. Presented in part at the Annual Meetings of the International Academy of Pathology, Canadian-American Division, Toronto, Ontario, March 1985, and the American Academy of Pediatrics, San Antonio, Texas, October 1985. Submitted for publication Sept. 9, 1985; accepted Feb. 12, 1986. Reprint requests: Stephen J. Boros, M.D., Children's Hospital, Rm. 2100, 345 N. Smith Ave., St. Paul, MN 55102.