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Successful management of a large bronchopleural fistula in a 3-yr-old child with high frequency jet ventilation (HFJV) is described. Respiratory insufficiency in the child occurred secondary to hemophilus influenza pneumonia. After 7 days of conventional ventilatory support, a bronchopleural fistula occurred with massive lung collapse and subcutaneous and mediastinal emphysema. The child was ventilated with a high frequency jet ventilator for 37 days with resulting healing of the fistula. During ventilatory support with HFJV, no sedation or muscle relaxants were needed. Two problem areas in long-term support in children were discussed, namely, partial tube obstruction because of thick secretion and the need for proper humidification. A significant advantage of HFJV was the ability to superimpose it on spontaneous breathing with elimination of sedation or muscle relaxants.
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