Safety and efficacy of high frequency jet ventilation: A systematic and narrative review

Background

High-Frequency Jet Ventilation (HFJV) is a specific modality of mechanical ventilation employed in certain operative and critical care settings. Despite its technical advantages, particularly in procedures requiring minimal organ motion, HFJV remains underutilised in routine clinical practice, largely due to limited high-quality evidence and the absence of formal national guidelines.

Objective

This systematic review aims to critically appraise the current evidence regarding the safety and efficacy of HFJV in adult and paediatric patients. The analysis covers both operating room and intensive care unit settings, and compares HFJV with conventional ventilation strategies.

Methods

A comprehensive literature search was conducted in accordance with PRISMA guidelines. We included 41 studies published after 1997, which were appraised using the Oxford Centre for Evidence-Based Medicine (OCEBM) levels of evidence and Cochrane risk-of-bias tools (RoB 2 and ROBINS-I).

Results

Most studies demonstrated favourable physiological and procedural outcomes with HFJV in intraoperative settings, The benefits were most notable during airway surgeries, tissue ablation procedures, and atrial fibrillation ablation.. In contrast, results in neonatal intensive care were heterogeneous, with some studies reporting improved gas exchange, while others indicated higher complication or mortality rates. Common limitations included small sample sizes, methodological heterogeneity, and risk of selection and publication bias. Volatile anaesthetic delivery was universally unfeasible, and HFJV performance was reduced in obese or COPD patients.

Conclusions

This review underscores the need for further research to optimise HFJV application and to better understand its long-term clinical impacts. The insights gained provide valuable guidance for future clinical use.