Relevance of high-frequency ventilation in neonatal surgery

Abstract

High-frequency ventilation, which we have termed “high-frequency positive-pressure ventilation” (HFPPV), can serve as an alternative to treatment by standard intermittent positive-pressure ventilation in certain types of acute respiratory distress in the newborn. Its use in the pre-, intra- and/or postoperative period in neonatal surgery is of interest if certain reservations are borne in mind: regarding technological requirements, a ventilator with low internal static compliance must be available; it must be possible to monitor various ventilatory parameters accurately: PaO₂, PaCO₂, airway pressure variations. We shall describe our experience at the Department of Pediatric Surgery of the C. H. U. in NANCY with three cases of esophageal atresia and ten cases of diaphragmatic hernia in children who benefited from this treatment. The indications for HFPPV are defined with regard to the advantages and disadvantages presented by this technique. When treating diaphragmatic hernias, there are benefits with regard to respiratory constants and control of airway pressure: reducing the peak pressure with improvement of PaO₂ and lowering of PaCO₂, which lowers the incidence of regression to fetal circulation (eight of ten infants survived). Then are also advantages in esophageal atresia: reduction of flow at the fistula, if present, and stabilization of the surgical field, thus facilitating surgery. The literature available on the types of procedures in which HFPPV can be beneficial is limited. Most of the studies have focused on the absence movement in the surgical field: open thoracic surgery, tracheal surgery, surgery for patent ductus arteriosus and microneurosurgery are all procedures in which this type of ventilation can be valuable.