Is proximal airway pressure a good reflection of peripheral airspace pressure in infants and children models under HFJV?

Abstract: This expriimental study was carried out to determine if an alveolar positive end-expiratory pressure (PEEP) could occur during high frequency jet ventilation (HFJV) in infants, and if tracheal pressure is a good estimation of alveolar pressure. We used physical models simulating a 1.5 kg premature (P), a 3 kg newborn (N) and a 6 kg child (C) with normal compliance and normal resistance. Moreover, in the N model, we used two different resistances and lung compliance heterogeneity was studied in the P model. Pressure was measured simultaneously in the tube simulating trachea (Paw) and in the bottle simulating the lung (Palv). HFJV was performed either via an endotracheal tube (ETT) or via a long catheter as in laryngoscopy. The ratio of injection time upon cycle duration (Ti/Ttot) was 20% or 30%, jet frequency was altered from 150 to 300 min⁻¹ and the driving pressure was set as in clinical practice (0.5 and 0.6 bar). PEEP occurred mainly in N (1.1 to 3.2 cm H2O) and C models (0 to 3.5 cm H2O). It was inversely related to expiratory time (Te). The end-expiratory pressure drop between Palv and Paw (ΔEEP) was higher in N and increased from 0.5 to 2 cm H2O with the shortening of Te and with airway resistances, i.e. the presence of ETT. In the heterogeneous model, PEEP and ΔEEP were greater in the higher compliance alveolus. This study shows that the end-expiratory Palv is underestimated by end-expiratory Paw. This is particularly important in the presence of an heterogeneity of distribution in lung compliance. In this case the airway PEEP overestimates the PEEP in the lower compliance alveolus and underestimates the PEEP in the higher compliance alveolus.