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Results for “High-Frequency Jet Ventilation”

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At least 19 recordsLinked to original sources
PubMed1992

High-frequency jet ventilation for respiratory failure after congenital heart surgery.

BACKGROUND: Extracorporeal membrane oxygenation (ECMO) is considered when respiratory failure (RF) persists despite increasing conventional mechanical ventilation (CMV). High-frequency jet ventilation (HFJV) can improve ventilation with comparable mean airway pressure (PAW) to that found on CMV. This study was undertaken to determine whether HFJV is an effective treatment and alternative to ECMO for RF after congenital heart surgery. METHODS AND RESULTS: HFJV was instituted in nine patients ranging in age from 6 days to 3.3 years with congenital heart disease meeting pulmonary criteria for ECMO. Indications for HFJV were pulmonary hypertension (six), adult-type respiratory distress syndrome (two), and pneumonitis (one). Seven patients (77%) were placed on HFJV within 24 hours of operation, and two patients required HFJV 2 weeks after operation. HFJV resulted in resolution of RF in eight of nine patients (89%). After 1 hour of HFJV, the arterial pH increased from 7.40 +/- 0.1 to 7.56 +/- 0.1 (p < 0.05) and the PaCO2 decreased from 44 +/- 15 to 29 +/- 12 mm Hg (p < 0.05). During HFJV there was no change in PaO2, although the FIO2 decreased from 0.99 +/- 0.0 to 0.73 +/- 0.2 (p < 0.05). There was no change in PAW, peak inspiratory pressures, positive end-expiratory pressures, heart rate, or mean arterial blood pressure during HFJV when compared with CMV. Mean duration of HFJV was 43 hours. Four patients were extubated and discharged from the hospital. Two patients were extubated but died from sepsis. Two patients had resolution of RF, but one died at reoperation and one from multisystem organ failure. The patient who failed HFJV therapy was placed on ECMO and died. CONCLUSIONS: This study suggests that HFJV improves ventilation and is an alternative to ECMO in patients with RF after surgery for congenital heart disease.

Child, Preschool↗
PubMedDate not supplied

Hemodynamic and respiratory effects of transtracheal high-frequency jet ventilation during difficult intubation.

STUDY OBJECTIVE: To evaluate the hemodynamic and respiratory effects of percutaneous transtracheal high-frequency jet ventilation (HFJV) during difficult intubation using fiberoptic bronchoscopy under general anesthesia. DESIGN: Prospective study. SETTING: Surgical patients scheduled for general anesthesia at the Medical College of Virginia Hospital. PATIENTS: Eight patients with known difficult airways. Three patients had deformed facial structures. One patient had temporomandibular joint impairment. Four patients had tumors of the oral cavity with deformed upper airways. INTERVENTIONS: A 13-gauge cricothyroidotomy jet ventilation cannula was inserted percutaneously under local anesthesia. Anesthesia was induced with etomidate 0.2 to 0.3 mg/kg, alfentanil 15 to 20 micrograms/kg, and vecuronium 0.1 mg/kg. HFJV was started with 100% oxygen at 30 to 35 pounds per square inch of driving pressure, 100 cycles per minute, and an inspiratory/expiratory ratio of 25%. Thoracic electrical bioimpedance was used to measure cardiac index (CI) and ejection fraction (EF). MEASUREMENTS AND MAIN RESULTS: Mean arterial pressure (MAP), heart rate (HR), CI, and EF were measured before induction of anesthesia; after 1 minute of HFJV, 5 minutes of HFJV, and 10 minutes of HFJV; and during positive pressure ventilation following fiberoptic intubation. Arterial blood gas samples were obtained before induction of anesthesia and after 10 minutes of HFJV. HR decreased significantly after 5 minutes of HFJV, after 10 minutes of HFJV, and after intubation (p less than 0.05). MAP decreased significantly after 10 minutes of HFJV compared with the preinduction value (mean, 97 to 71 mmHg; p less than 0.01). Although EF increased significantly following intubation, from 46% to 59%, there were no significant changes in CI. Arterial oxygen tension increased from 85 to 240 mmHg (p less than 0.05). Arterial carbon dioxide tension also increased, from 39 to 42 mmHg (p less than 0.05). CONCLUSIONS: Transtracheal HFJV under general anesthesia with etomidate, alfentanil, and vecuronium provided satisfactory hemodynamic conditions and pulmonary gas exchange. Percutaneous transtracheal HFJV can be used safely to manage patients with a difficult airway under general anesthesia using fiberoptic bronchoscopy.

Anesthesia, Intravenous↗
PubMed1992

Management of a piglet model of the meconium aspiration syndrome with high-frequency or conventional ventilation.

OBJECTIVE: To assess the usefulness of three methods of high-frequency ventilation in the early management of a piglet model of the meconium aspiration syndrome. DESIGN: Randomized, block design. SETTING: Animal research facility. SUBJECTS: Fifty-six mixed-breed newborn piglets aged 1 to 4 days and weighing 1.8 to 2.7 kg. INTERVENTIONS: After instillation of a 2.2-mL/kg solution of 25% meconium, 56 piglets were randomized to receive treatment with (1) a conventional positive-pressure infant ventilator, (2) the Bunnell Life Pulse high-frequency jet ventilator, (3) the Bird model VDR high-frequency flow interruptor, or (4) the Infant Star high-frequency flow interruptor. We adjusted ventilator settings to maintain partial pressures of arterial oxygen (PaO2) of 80 to 120 cm H2O and partial pressures of arterial carbon dioxide (PaCO2) of 30 to 50 cm H2O during the 6 hours of ventilation. MEASUREMENTS AND MAIN RESULTS: We compared pulmonary histologic alterations and four physiologic parameters: (1) mean airway pressure, (2) PaCO2, (3) ratio of PaO2 to partial alveolar oxygen pressure (PAO2), and (4) oxygenation index ([(fraction of inspired oxygen)(mean airway pressure)(100)]/PaO2). The two measures of oxygenation were similar for all four devices except at 4 hours, when the PaO2/PAO2 ratio on positive-pressure ventilation was significantly higher than that on high-frequency jet ventilation (P = .008). The histologic changes on positive-pressure ventilation (atelectasis, inflammation, presence of meconium, and exudative debris) were significantly worse than those on high-frequency jet ventilation or flow interruption (P < .0001). CONCLUSIONS: The finding of less severe pathologic alterations with various types of high-frequency ventilators justifies further investigations into the management of the meconium aspiration syndrome with these devices.

Animals↗
PubMed1992

Retrograde intubation--a facilitated approach.

The procedure of retrograde tracheal intubation has been facilitated by the use of a multilumen catheter guide. When used as an anterograde guide, it would easily follow the retrograde guide and would direct placement of the tracheal tube atraumatically. A new technique is described that allows stabilization of the anterograde catheter and its insertion deep inside the trachea to prevent dislodgement of the tracheal tube from the laryngeal inlet. This catheter guide may also be used as a conduit for high-frequency jet ventilation with monitoring of the airway pressure, thus providing wider margins of safety in patients with difficult upper airways.

Catheterization↗
PubMedDate not supplied

[Tracheal rupture during a transhiatal esophagectomy without thoracotomy. Intra- and postoperative treatment].

We report the case of a male patient with a carcinoma of the upper third of the esophagus who presented a tracheal rupture during a transhiatal esophagectomy. The clinical picture was characterized by a severe alteration of the ventilatory function that required selective intubation and, later on, a right thoracotomy for repairing the tracheal lesion. After surgery the patient was treated at the Recovery Unit. He received high-frequency mechanic ventilation (jet ventilation type) during nine days in a attempt to decrease the risk for dehiscence of the tracheal suture and to ensure an adequate oxygenation and hemodynamic control. The clinical course was favourable.

Carcinoma, Squamous Cell↗
PubMed1992

New methods of dealing with the complications of panendoscopy.

A 70-year-old man with chronic obstructive airways disease was scheduled to undergo panendoscopy following a course of radiotherapy for carcinoma of the larynx. He was anaesthetized using a propofol infusion and high frequency jet ventilation (HFJV). The jet ventilation catheter was left in situ at the end of the procedure. This enabled oxygenation to be maintained in the presence of post-operative laryngospasm by re-attaching the jet ventilator. Subsequently he developed respiratory failure, and a Bullard laryngoscope was used to visualize the vocal folds despite oedema of the tumour which made direct laryngoscopy impossible. A catheter was passed through the biopsy channel of the Bullard, enabling HFJV to be commenced. A conventional endotracheal tube was then railroaded over the catheter to facilitate conventional ventilation.

Aged↗
PubMed1992

Laryngospasm during transtracheal high frequency jet ventilation.

A 74-year-old woman developed severe cardiovascular depression during percutaneous transtracheal high frequency jet ventilation for laser surgery of the epiglottis. This was found to be caused by acute airway obstruction secondary to severe laryngospasm. We recommend profound neuromuscular blockade during percutaneous transtracheal jet ventilation, in order to prevent this complication.

Aged↗
PubMed1991

Removal of a laryngeal foreign body using high frequency jet ventilation.

Aspiration of a foreign body into the respiratory tract is a common and serious accident in childhood. Laryngotracheal foreign bodies, although less common than bronchial foreign bodies, are potentially more dangerous. Removal is commonly achieved using a rigid ventilating bronchoscope. We report a 16-month-old boy who had an open safety pin impacted in his larynx. This was removed through a tracheostomy, using high frequency jet ventilation to maintain gaseous exchange. We believe that this is the first case in which this method of removal has been reported.

Bronchoscopy↗
PubMed1992

[Transtracheal jet ventilation in the operating room].

For the last 40 years transtracheal ventilation has been suggested as a means of bypassing the glottis in emergency in patients unable to be intubated or ventilated by mask. A catheter has been designed to be easily inserted into the crico-thyroid membrane. The outer part of the device, with its dual attachment system, can be connected to conventional resuscitation equipment by its 15 mm male end or to a high-pressure oxygen source by its Luer-Lock fitting. The advantages of transtracheal ventilation are: a clear vision of the operative field, a good gas exchange, an elimination of airway trauma from intubation, a reduction of the hazard of airway fires and a decreased risk of aspiration of blood and debris. Barotrauma is the main danger. However, this method of providing oxygen and/or mechanical ventilation may be extended to the postoperative period, the exit of the insufflated gas mixture being assured at all times.

Anesthesia, Inhalation↗
PubMed1992

Elective transtracheal jet ventilation for bronchoscopic removal of tracheal foreign body.

We have shown that transtracheal jet ventilation can be used safely and effectively when removing a foreign body from the airway. In some cases, it may be wise to choose this method of ventilation initially, thus avoiding the difficulties associated with more conventional modes of controlled ventilation. This is especially true when the potential for loss of the airway during the procedure is significant. This technique also allows the bronchoscopist the benefit of unimpeded access to the airway and adequate uninterrupted time for his operative procedure.

Bronchoscopy↗
PubMed1992

An experimental randomized study of five different ventilatory modes in a piglet model of severe respiratory distress.

OBJECTIVES: To characterize different modes of pressure- or volume-controlled mechanical ventilation with respect to their short-term effects on oxygen delivery (DO2). Furthermore to investigate whether such differences are caused by differences in pulmonary gas exchange or by airway-pressure-mediated effects on the central hemodynamics. DESIGN: After inducing severe respiratory distress in piglets by removing surfactant, 5 ventilatory modes were randomly and sequentially applied to each animal. SETTING: Experimental laboratory of a university department of Anesthesiology and Intensive Care. ANIMALS: 15 piglets after repeated bronchoalveolar lavage. INTERVENTIONS: Volume-controlled intermittent positive-pressure ventilation (IPPV) with either 8 or 15 cmH2O PEEP; pressure-controlled inverse ratio ventilation (IRV); pressure-controlled high-frequency positive-pressure ventilation (HFPPV) and pressure-controlled high frequency ventilation with inspiratory pulses superimposed (combined high frequency ventilation, CHFV). The prefix (L) indicates that lavage has been performed. MEASUREMENTS AND RESULTS: Measurements of gas exchange, airway pressures, hemodynamics, functional residual capacity (using the SF6 method), intrathoracic fluid volumes (using a double-indicator dilution technique) and metabolism were performed during ventilatory and hemodynamic steady state. The peak inspiratory pressures (PIP) were significantly higher in the volume-controlled low frequency modes (43 cmH2O for L-IPPV-8 and L-IPPV-15) than in the pressure-controlled modes (39 cmH2O for L-IRV, 35 cmH2O for L-HFPPV and 33 cmH2O for L-CHFV, with PIP in the high-frequency modes being significantly lower than in inverse ratio ventilation). The mean airway pressure (MPAW) after lavage was highest with L-IRV (26 cmH2O). In the ventilatory modes with a PEEP > 8 cmH2O PaO2 did not differ significantly and beyond this "opening threshold" MPAW did not further improve PaO2. Central hemodynamics were depressed by increasing airway pressures. This is especially true for L-IRV in which we found the highest MPAW and at the same time the lowest stroke index (74% of IPPV). CONCLUSIONS: In this model, as far as oxygenation is concerned, it does not matter in which specific way the airway pressures are produced. As far as oxygen transport is concerned, i.e. aiming at increasing DO2, we conclude that optimizing the circulatory status must take into account the circulatory influence of different modes of positive pressure ventilation.

Airway Resistance↗
PubMed1992

Clinical studies on high frequency two-way jet ventilation.

A new mode of jet ventilation, high frequency two-way jet ventilation (HFTJV) was devised and introduced to increase carbon dioxide elimination during jet ventilation. Its ventilatory efficiency and features were investigated and compared with those of high frequency jet ventilation (HFJV) in 10 patients with normal cardiopulmonary function. Random sample selection and randomized cross-over trial were used for comparison between HFTJV and HFJV at the same ventilatory settings of driving pressure 1 kg/cm2 (14.22 Psi), respiratory rate 100/min and I/E ratio 1:2. Peak inspiratory pressure (PIP), end-expiratory pressure (EEP) and main variables of air blood gas analysis (PaO2, PaCO2, pH) were measured and recorded during the use of HFJV and HFTJV. PIP and EEP were significantly lower than with HFTJV than with HFJV. EEP of HFTJV showed a slightly negative pressure (-0.17 +/- 0.03 kPa). PaCO2 with HFTJV was significantly lower than that with HFJV, but PaO2 and pH with HFTJV were significantly higher than those with HFJV. HFTJV was shown to have a ventilatory feature of decreasing airway pressure and simultaneously increasing carbon dioxide elimination, as compared with HFJV. Whether this ventilatory feature of HFTJV can be utilized for various respiratory support in patients with abnormal cardiopulmonary function needs to be further studied.

Adult↗