High-frequency jet ventilation produces auto-PEEP

Positive-pressure ventilation can increase dead space by trapping gas, especially at high frequencies. Under conditions of high airway resistance and high pulmonary compliance, gas trapping can increase alveolar pressure without affecting proximal airway pressure, due to impedance to expiratory gas flow. The difference between alveolar pressure and proximal airway pressure at end-expiration has been called auto-PEEP. Using a mechanical test lung, we altered compliance and resistance under a variety of high-frequency jet ventilator settings to evaluate the generation of auto-PEEP. High driving pressures and prolonged inspiratory times significantly increased gas trapping. This effect was most pronounced when both airway resistance and pulmonary compliance were elevated. These findings support the concept that high-frequency jet ventilation (HFJV) may have deleterious side-effects in patients with chronic obstructive pulmonary disease.