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Li J, Xu S, Yang R, Ding M. Effectiveness and Safety of Superimposed High-Frequency Jet Ventilation in Rigid Bronchoscopy: A Single-Center, Retrospective Study. EAR, NOSE & THROAT JOURNAL 2024:1455613241261594. [PMID: 38907650 DOI: 10.1177/01455613241261594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/24/2024] Open
Abstract
Introduction: Superimposed high-frequency jet ventilation (SHFJV) is a new type of jet ventilation, but its safety and effectiveness in rigid bronchoscopy have not been fully verified, especially in patients with airway stenosis and preoperative cardiovascular disease. This study is intended to retrospectively analyze the effectiveness and safety of SHFJV in the endobronchial treatment under rigid bronchoscopy. Methods: A total of 363 patients were included in this study. They were divided into 2 groups: Group A (n = 176)-presence of airway stenosis; Group B (n = 187)-absence of airway stenosis. Mean arterial pressure, heart rate, and pulse oxygen saturation were recorded before anesthesia and during the procedure. Arterial blood gases was recorded before anesthesia, at the end of the procedure and second-day postoperation respectively. The duration of procedure, extubation time, length of stay in the postanesthesia care unit (PACU), length of postoperative hospitalization, incidence of intraoperative and postoperative complications as well as 30 day mortality were also recorded. Results: All the patients had stable circulation during the procedure, including that with preoperative cardiovascular and pulmonary diseases. There were no substantial differences observed in terms of extubation time, PACU stay, and postoperative hospital days. Patients with severe preoperative airway stenosis exhibited longer procedure duration compared to those with mild to moderate stenosis, but there was no difference noted in terms of the extubation and PACU time. Conclusion: SHFJV is effective and safe in the endobronchial treatment for patients with airway stenosis and preoperative cardiovascular disease. It can serve as an ideal airway management strategy for rigid bronchoscopy.
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Affiliation(s)
- Jing Li
- Department of Anesthesiology, Zhongda Hospital, Southeast University, Nanjing, China
| | - Shixia Xu
- Department of Anesthesiology, Zhongda Hospital, Southeast University, Nanjing, China
| | - Rongna Yang
- School of Medicine, Southeast University, Nanjing, China
| | - Ming Ding
- Department of Respiratory and Critical Care Medicine, Zhongda Hospital, Southeast University, Nanjing, China
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Min SH, Seo JH. Tube or tubeless: an anesthetic strategy for upper airway surgery. Anesth Pain Med (Seoul) 2023; 18:123-131. [PMID: 37183280 PMCID: PMC10183614 DOI: 10.17085/apm.23014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Accepted: 03/15/2023] [Indexed: 05/16/2023] Open
Abstract
Since the patient's airway is shared between an anesthesiologist and a surgeon, airway management during upper airway surgery can be challenging. Beyond the conventional method of general anesthesia, high-flow nasal oxygenation (HFNO) has recently been used as a key technique for tubeless anesthesia. HFNO provides humidified, heated oxygen up to 70 L/min, which promises improved oxygenation and ventilation, allowing for prolonged apneic oxygenation. In previous physiological and clinical studies, HFNO has been demonstrated that tubeless anesthesia safely provide an uninterrupted surgical field during laryngeal surgeries. Although tubeless anesthesia remains uncommon, it can be a good alternative to conventional anesthesia if an anesthesiologist and a surgeon select appropriate patients together with sufficient experience. A safe strategy for tubeless anesthesia, along with appropriate backup plans, including endotracheal intubation and high-frequency jet ventilation, should be considered for upper airway surgery.
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Affiliation(s)
- Se-Hee Min
- Department of Anesthesiology and Pain Medicine, Chung-Ang University Gwangmyeong Hospital, Gwangmyeong, Korea
| | - Jeong Hwa Seo
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul, Korea
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Wang T, Pei Y, Qiu X, Wang J, Wang Y, Zhang J. A multi-centre prospective random control study of superimposed high-frequency jet ventilation and conventional jet ventilation for interventional bronchoscopy. EAR, NOSE & THROAT JOURNAL 2022:1455613221094441. [PMID: 35404691 DOI: 10.1177/01455613221094441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Introduction: Superimposed high-frequency jet ventilation (SHFJV) is a new type of jet ventilation that simultaneously uses high- and low-frequency types of jet ventilation. We compared SHFJV with the conventional high-frequency jet ventilation (CHFJV) in interventional bronchoscopy in terms of safety and effectiveness. Methods: A multi-centre prospective random single-blind clinical trial was conducted by three interventional bronchoscopy centres. Patients who underwent diagnostic or therapeutic bronchoscopy under general anaesthesia were admitted and divided into two groups: SHFJV group (trial group) and CHFJV group (control group). PaO2 and PaCO2 were recorded before anaesthesia and during and after the procedure. SpO2 and etCO2 were recorded every 10 min throughout the procedure. Patients were observed until 24 h post-bronchoscopy. Results: Sixty patients were included in the study. Twenty-nine were in the trial group, and 31 were in the control group. Both groups had no significant differences in demographic data. In the control group, the PaO2 measured in the operation was higher than that in the trial group (p = 0.023). The values of etCO2 in the control group were more dispersed than those of the trial group. When the procedure time was over 90 minutes, the etCO2 in the control group significantly increased (p = 0.01), while the etCO2 in trial group remained stable (p = 0.594). There were more patients with PaCO2 ≥ 50 mmHg during the procedure in the control group than in the trial group (p = 0.042). Conclusion: SHFJV is effective and safe in interventional bronchoscopy. It may provide more effective and stabilised ventilation than CHFJV in cases with long procedure times.
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Affiliation(s)
- Ting Wang
- Department of Respiratory and Critical Care Medicine, Beijing Tiantan Hospital, 105738Capital Medical University, Beijing, China
| | - Yinghua Pei
- Department of Respiratory and Critical Care Medicine, Beijing Tiantan Hospital, 105738Capital Medical University, Beijing, China
| | - Xiaojian Qiu
- Department of Respiratory and Critical Care Medicine, Beijing Tiantan Hospital, 105738Capital Medical University, Beijing, China
| | - Juan Wang
- Department of Respiratory and Critical Care Medicine, Beijing Tiantan Hospital, 105738Capital Medical University, Beijing, China
| | - Yuling Wang
- Department of Respiratory and Critical Care Medicine, Beijing Tiantan Hospital, 105738Capital Medical University, Beijing, China
| | - Jie Zhang
- Department of Respiratory and Critical Care Medicine, Beijing Tiantan Hospital, 105738Capital Medical University, Beijing, China
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Huh G, Min SH, Cho SD, Cho YJ, Kwon SK. Application and Efficiency of Transnasal Humidified Rapid-Insufflation Ventilatory Exchange in Laryngeal Microsurgery. Laryngoscope 2021; 132:1061-1068. [PMID: 34495557 DOI: 10.1002/lary.29848] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Revised: 05/26/2021] [Accepted: 08/16/2021] [Indexed: 11/10/2022]
Abstract
OBJECTIVES/HYPOTHESIS This study aimed to analyze the feasibility of transnasal humidified rapid-insufflation ventilatory exchange (THRIVE) during laryngeal microsurgery (LMS) and investigated its efficiency and application according to the location of the lesion. STUDY DESIGN Retrospective chart review. METHODS Patients over 20 years of age who underwent LMS without underlying cardiac, pulmonary, or cerebrovascular disease were retrospectively reviewed. Overall, 54 patients with endotracheal intubation (ETI) and 44 patients with THRIVE were included. The operation and anesthesia time, induction and emergence time, oxygen saturation (SpO2 ), and transcutaneous carbon dioxide (TcCO2 ) levels were analyzed and compared between the two ventilation methods according to disease subsite. RESULTS Compared with ETI, patients with THRIVE presented reduced operation time (16.3 ± 9.69 min vs. 21.9 ± 12.0 min), anesthesia time (33.6 ± 11.4 min vs. 45.4 ± 13.9 min), emergence time (6.73 ± 2.49 min vs. 8.52 ± 3.17 min), without significant decreases in SpO2 but with increased TcCO2 (10.9 ± 6.12% vs. 7.33 ± 3.86%). Comparing THRIVE to ETI for lesions at the glottis yielded similar findings, which were particularly more significant. However, lesions above the glottis presented no significant difference for any parameters between THRIVE and ETI groups. Lesions involving multiple subsites and prolonged operation time were risk factors for the intraoperative conversion of ventilation method. CONCLUSION THRIVE is reliable for maintaining oxygenation during LMS and is efficient in reducing the operation and emergence times, leading to shorter anesthesia time, especially for lesions at the glottis. However, caution is required administering THRIVE, when lesion involves multiple subsites, and when operation time is prolonged. LEVEL OF EVIDENCE 3 Laryngoscope, 2021.
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Affiliation(s)
- Gene Huh
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University Hospital, Seoul, Republic of Korea.,Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Se-Hee Min
- Department of Anesthesiology and Pain Medicine, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Republic of Korea
| | - Sung-Dong Cho
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University Hospital, Seoul, Republic of Korea.,Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Youn Joung Cho
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Seong Keun Kwon
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University Hospital, Seoul, Republic of Korea.,Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University College of Medicine, Seoul, Republic of Korea.,Cancer Research Institute, Seoul National University, Seoul, Republic of Korea.,Sensory Organ Research Institute, Seoul National University Medical Research Center, Seoul, Republic of Korea
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Endoscopy of the Pharynx and Oesophagus. Dysphagia 2018. [DOI: 10.1007/174_2017_130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Influence of Tracheal Obstruction on the Efficacy of Superimposed High-frequency Jet Ventilation and Single-frequency Jet Ventilation. Anesthesiology 2015; 123:799-809. [PMID: 26259137 DOI: 10.1097/aln.0000000000000818] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Both superimposed high-frequency jet ventilation (SHFJV) and single-frequency (high-frequency) jet ventilation (HFJV) have been used with success for airway surgery, but SHFJV has been found to provide higher lung volumes and better gas exchange than HFJV in unobstructed airways. The authors systematically compared the ventilation efficacy of SHFJV and HFJV at different ventilation frequencies in a model of tracheal obstruction and describe the frequency and obstruction dependence of SHFJV efficacy. METHODS Ten anesthetized animals (weight 25 to 31.5 kg) were alternately ventilated with SHFJV and HFJV at a set of different fHF from 50 to 600 min. Obstruction was created by insertion of interchangeable stents with ID 2 to 8 mm into the trachea. Chest wall volume was measured using optoelectronic plethysmography, airway pressures were recorded, and blood gases were analyzed repeatedly. RESULTS SHFJV provided greater than 1.6 times higher end-expiratory chest wall volume than HFJV, and tidal volume (VT) was always greater than 200 ml with SHFJV. Increase of fHF from 50 to 600 min during HFJV resulted in a more than 30-fold VT decrease from 112 ml (97 to 130 ml) to negligible values and resulted in severe hypoxia and hypercapnia. During SHFJV, stent ID reduction from 8 to 2 mm increased end-expiratory chest wall volume by up to 3 times from approximately 100 to 300 ml and decreased VT by up to 4.2 times from approximately 470 to 110 ml. Oxygenation and ventilation were acceptable for 4 mm ID or more, but hypercapnia occurred with the 2 mm stent. CONCLUSION In this in vivo porcine model of variable severe tracheal stenosis, SHFJV effectively increased lung volumes and maintained gas exchange and may be advantageous in severe airway obstruction.
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Nowak A, Usichenko T, Wendt M, Klemm E. Methods of administering superimposed high-frequency jet ventilation and the associated risk for aspiration in a model of tracheal bleeding. ACTA ACUST UNITED AC 2012; 85:59-63. [PMID: 23107666 DOI: 10.1159/000343561] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2012] [Accepted: 09/15/2012] [Indexed: 11/19/2022]
Abstract
BACKGROUND To determine the suitability of different superimposed high-frequency jet ventilation (SHFJV) application methods during tracheal bleeding. OBJECTIVE To determine the effect of SHFJV on the aspiration of blood during tracheal bleeding. METHODS A test lung was ventilated using SHFJV via a rigid endoscope, a jet laryngoscope and a 4-lumen jet catheter. Packed red blood cells (PRBCs) were injected into the artificial trachea caudally to the rigid endoscope and jet laryngoscope ventilation, and both caudally and cranially during ventilation via the 4-lumen jet catheter, and the migration of PRBCs during ventilation was studied using continuous video recording. RESULTS Migration of blood into the lower respiratory tract did not occur during SHFJV via the rigid endoscope and jet laryngoscope and via the 4-lumen jet catheter with the bleeding caudal to ventilation source. If the bleeding was cranial to the 4-lumen jet catheter ventilation, migration of blood into the lower respiratory tract was seen when reflux of blood reached the entrainment area. From this area, blood is transported within the jet stream into the lower respiratory tract. CONCLUSIONS SHFJV protects the lower respiratory tract from blood aspiration in case of tracheal bleeding. During SHFJV via the 4-lumen jet catheter, aspiration of blood only occurs if bleeding is localized cranial to the 4-lumen jet catheter ventilation. In case of heavy tracheal bleeding, the jet sources should be positioned cranial to the site of bleeding.
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Affiliation(s)
- Andreas Nowak
- Department of Anesthesiology and Intensive Care Medicine, Emergency Medicine and Pain Management, Dresden Friedrichstadt Hospital, Academic Teaching Hospital, Technical University of Dresden, Dresden, Germany.
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Endoscopy of the Pharynx and Esophagus. Dysphagia 2012. [DOI: 10.1007/174_2012_634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Thurnher D, Erovic BM, Frommlet F, Brannath W, Ehrenberger K, Jansen B, Selzer E, Grasl MC. Challenging a dogma – Surgery yields superior long-term results for T1a squamous cell carcinoma of the glottic larynx compared to radiotherapy. Eur J Surg Oncol 2008; 34:692-8. [PMID: 17686606 DOI: 10.1016/j.ejso.2007.06.008] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2007] [Accepted: 06/20/2007] [Indexed: 10/23/2022] Open
Abstract
AIMS The aim of this study was to compare laser surgery, conventional endoscopic surgery and radiotherapy in the treatment of early T1a glottic cancer. METHODS We conducted a retrospective analysis of patients with early vocal cord cancer (who underwent either conventional surgery via endoscopy or laryngofissur, or primary radiotherapy) at the Medical University of Vienna. By univariate and multivariate Cox regression models the influence of treatment and other parameters on survival and locoregional control were analysed. RESULTS 337 Patients were analyzed with a mean follow-up period of 133.8 months. Overall survival rates where similar in all three treatment groups. Five-year, 10-year and 15-year estimates of disease specific survival for laser-treated patients were 100%, for conventional surgery were 100%, 98% and 98%, and for radiotherapy were 96%, 92% and 91%, respectively. Locoregional recurrences were observed after laser surgery in 10%, after conventional surgery in 13% and after radiotherapy in 30% of the patients treated. According to the log-rank test, time to relapse was significantly shorter for irradiated patients compared to patients who underwent surgery (p < 0.0001). Mortality caused by the laryngeal tumour was significantly higher in the radiotherapy group (p = 0.003). CONCLUSION Patients undergoing laser or conventional surgery have a significantly lower incidence of locoregional recurrences and longer disease-free intervals when compared to patients treated by radiotherapy.
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Affiliation(s)
- D Thurnher
- Department of Otorhinolaryngology, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria
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Rezaie-Majd A, Bigenzahn W, Denk DM, Burian M, Kornfehl J, Grasl MC, Ihra G, Aloy A. Superimposed high-frequency jet ventilation (SHFJV) for endoscopic laryngotracheal surgery in more than 1500 patients. Br J Anaesth 2006; 96:650-9. [PMID: 16574723 DOI: 10.1093/bja/ael074] [Citation(s) in RCA: 60] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Superimposed high-frequency jet ventilation (SHFJV), which does not require any tracheal tubes or catheters, was developed specifically for use in laryngotracheal surgery. SHFJV uses two jet streams with different frequencies simultaneously and is applied in the supraglottic space using a jet laryngoscope and jet ventilator. METHODS Between 1990 and 2004, SHFJV was studied in 1515 consecutive patients (including 158 children requiring laryngotracheal surgery) prospectively. Ventilation was performed with an air/oxygen mixture and anaesthesia was administered i.v. RESULTS Adequate oxygenation and ventilation was achieved in 1512 patients. Arterial blood gas analyses (BGA) were performed between 1990 and 1994; thereafter BGA was only performed in patients with high-grade stenosis of the larynx/trachea or high-risk patients [n=623, mean Pa(O(2)) 133.8 (39.4) mm Hg and mean Pa(CO(2)) 42.3 (10.1) mm Hg]. There were no significant changes in Pa(O(2)) or Pa(CO(2)) during the entire period of SHFJV. No complications secondary to the ventilation technique were observed; in particular, no barotrauma occurred. Three patients required tracheal intubation. SHFJV was also successfully used for laser surgery (n=312). It proved to be a safe mode of ventilation without any complications such as airway fire, major haemorrhage, or aspiration of debris. CONCLUSION SHFJV is an advanced ventilation mode playing a pivotal role in the (open) ventilatory support/ventilation of patients with laryngotracheal stenosis. It is particularly indicated in cases of severe stenosis and offers optimal conditions for laryngotracheal surgery, including laser surgery and stent implantation techniques.
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Affiliation(s)
- A Rezaie-Majd
- Department of Anaesthesia and General Intensive Care (A), Vienna General Hospital, Medical University of Vienna Waehringer Guertel 18-20, A-1090 Vienna, Austria.
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Ihra G, Gockner G, Kashanipour A, Aloy A. High-frequency jet ventilation in European and North American institutions: developments and clinical practice. Eur J Anaesthesiol 2000. [DOI: 10.1097/00003643-200007000-00003] [Citation(s) in RCA: 42] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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13
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Thaung MK, Balakrishnan A. A modified technique of tubeless anaesthesia for microlaryngoscopy and bronchoscopy in young children with stridor. Paediatr Anaesth 2000; 8:201-4. [PMID: 9608963 DOI: 10.1046/j.1460-9592.1998.00732.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Sixty children including neonates and infants, with stridor undergoing investigations under general anaesthesia, were studied retrospectively. General anaesthesia was induced using an inhalational technique with halothane and was maintained with propofol infusion without the use of tracheal intubation. The ages ranged from three days to two years and five months. In most of the cases after propofol infusion, there was a slight drop in blood pressure without change in heart rate. This modified technique was found to be satisfactory in most of the cases.
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Affiliation(s)
- M K Thaung
- Department of Anaesthesia & Surgical Intensive Care, Singapore General Hospital, Singapore
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Bacher A, Pichler K, Aloy A. Supraglottic combined frequency jet ventilation versus subglottic monofrequent jet ventilation in patients undergoing microlaryngeal surgery. Anesth Analg 2000; 90:460-5. [PMID: 10648340 DOI: 10.1097/00000539-200002000-00041] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
UNLABELLED We compared the efficacy of gas exchange during supraglottic combined-frequency jet ventilation via a jet ventilation laryngoscope and during monofrequent jet ventilation via the Mon-Jet catheter (Xomed, Jacksonville, FL). Twenty-three anesthetized (propofol, fentanyl, vecuronium) patients undergoing microlaryngeal surgery were prospectively studied and randomly assigned to one of two groups. The patients' lungs were ventilated with combined-frequency jet ventilation (10 min, 15 and 600 breaths/min, inspiration/expiration time ratio = 1, driving pressure 750-1500 mm Hg), monofrequent (low-frequency group: 15 breaths/min; high-frequency group: 600 breaths/min) jet ventilation (20 min), and again combined-frequency jet ventilation (15 min). PaO(2), PaCO(2), and the inspiratory oxygen fraction (FIO(2)) were measured. Wilcoxon's signed rank test was applied. During monofrequent jet ventilation, PaCO(2) increased and the PaO(2)/FIO(2) decreased significantly (P < 0.05) as compared with combined-frequency jet ventilation (low-frequency group: PaCO(2) from 39.4 +/- 3.3 to 50. 8 +/- 8.0 mm Hg, PaO(2)/FIO(2) from 306 +/- 100 to 225 +/- 94 mm Hg; high-frequency group: PaCO(2) from 36.7 +/- 7.2 to 60.3 +/- 6.1 mm Hg, PaO(2)/FIO(2) from 429 +/- 87 to 190 +/- 51 mm Hg; mean +/- SD). After switching back to combined-frequency jet ventilation, PaCO(2) decreased and PaO(2)/FIO(2) increased to baseline levels. We conclude that gas exchange during microlaryngeal surgery can be more easily maintained with supraglottic combined-frequency jet ventilation than with subglottic monofrequent jet ventilation via the Mon-Jet catheter. IMPLICATIONS This study demonstrates that the combination of high- and low-frequency supraglottic jet ventilation via a jet ventilation laryngoscope provides a better pulmonary gas exchange and allows more accurate airway pressure monitoring during microlaryngeal surgery than subglottic monofrequent jet ventilation via an endotracheal catheter.
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Affiliation(s)
- A Bacher
- Department of Anesthesiology and General Intensive Care, University of Vienna, Austria.
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Bacher A, Pichler K, Aloy A. Supraglottic Combined Frequency Jet Ventilation Versus Subglottic Monofrequent Jet Ventilation in Patients Undergoing Microlaryngeal Surgery. Anesth Analg 2000. [DOI: 10.1213/00000539-200002000-00041] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Ihra G, Kolev N, Zakel D, Kepka A, Schabernig C, Aloy A. Transesophageal echocardiographic assessment of right heart hemodynamics during high-frequency jet ventilation. J Clin Anesth 1999; 11:32-8. [PMID: 10396716 DOI: 10.1016/s0952-8180(98)00125-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
STUDY OBJECTIVE To evaluate right ventricular dimensions and function by echocardiography in anesthetized patients during superimposed high-frequency jet ventilation (HFJV). DESIGN Prospective clinical study. SETTING University hospital operating room. PATIENTS 20 ASA physical status I patients undergoing elective minor otorhinolaryngological surgery, and undergoing conventional mechanical ventilation with subsequent superimposed HFJV. INTERVENTIONS Two-dimensional transesophageal echocardiography with a 5-MHz multiplane transducer to determine right ventricular dimensions and function from a mid-esophageal view. Insertion of a radial artery catheter for monitoring blood pressure and blood gases. MEASUREMENTS AND MAIN RESULTS Heart rate, mean arterial blood pressure, and right ventricular end-diastolic and end-systolic volumes determined by echocardiography, stroke volume, and ejection fraction. Measurements were performed after 10 minutes of conventional positive pressure ventilation (control) and after 10 minutes of subsequent superimposed HFJV at similar peak and positive end-expiratory airway pressures. Right ventricular systolic and diastolic volumes, stroke volume, and ejection fraction did not reveal statistical significant differences after transition to HFJV. Interventricular septum did not show any abnormalities in motion. In contrast, interatrial septum demonstrated momentary mid-systolic bows toward the left atrium in 9 of 17 patients (53%) during conventional ventilation, but in 15 of 17 patients (88%) during jet ventilation. Heart rate and mean arterial blood pressure remained unchanged, but arterial oxygen tension values were higher and arterial carbon dioxide tension values lower during HFJV. CONCLUSION Transesophageal echocardiographic evaluation of right heart hemodynamics did not show any significant difference after transition of ventilation to superimposed HFJV applying similar airway pressures. Furthermore, superimposed HFJV was safe and effective, it improved oxygenation, and it facilitated carbon dioxide elimination.
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Affiliation(s)
- G Ihra
- Department of Anesthesiology and Intensive Care Medicine, University of Vienna, Austria
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Kraincuk, Kepka, Ihra, Schabernig, Aloy. A new prototype of an electronic jet-ventilator and its humidification system. Crit Care 1999; 3:101-110. [PMID: 11056732 PMCID: PMC29022 DOI: 10.1186/cc351] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/1998] [Revised: 06/21/1999] [Accepted: 07/06/1999] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND: Adequate humidification in long-term jet ventilation is a critical aspect in terms of clinical safety. AIM: To assess a prototype of an electronic jet-ventilator and its humidification system. METHODS: Forty patients with respiratory insufficiency were randomly allocated to one of four groups. The criterion for inclusion in this study was respiratory insufficiency exhibiting a Murray score above 2. The four groups of patients were ventilated with three different respirators and four different humidification systems. Patients in groups A and B received superimposed high-frequency jet ventilation (SHFJV) by an electronic jet-ventilator either with (group A) or without (group B) an additional humidification system. Patients in group C received high-frequency percussive ventilation (HFPV) by a pneumatic high-frequency respirator, using a hot water humidifier for warming and moistening the inspiration gas. Patients in group D received conventional mechanical ventilation using a standard intensive care unit respirator with a standard humidification system. SHFJV and HFPV were used for a period of 100 h (4days). RESULTS: A significantly low inspiration gas temperature was noted in patients in group B, initially (27.2 +/- 2.5 degrees C) and after 2 days (28.0 +/- 1.6 degrees C) (P < 0.05). The percentage of relative humidity of the inspiration gas in patients in group B was also initially significantly low (69.8 +/- 4.1%; P < 0.05) but rose to an average of 98 +/- 2.8% after 2 h. The average percentage across all four groups amounted to 98 +/- 0.4% after 2 h. Inflammation of the tracheal mucosa was found in patients in group B and the mucosal injury score (MIS) was significantly higher than in all the other groups. Patients in groups A, C and D showed no severe evidence of airway damage, exhibiting adequate values of relative humidity and temperature of the inspired gas. CONCLUSION: The problems of humidification associated with jet ventilation can be fully prevented by using this new jet-ventilator. These data were sustained by nondeteriorating MIS values at the end of the 4-day study period in groups A, C and D.
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Affiliation(s)
- Kraincuk
- Department of Anesthesiology and General Intensive Care, University of Vienna, Austria.
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Ihra G, Kepka A, Schabernig C, Hieber C, Kashanipour A, Aloy A. High-frequency ventilation for management of respiratory complications after trauma and major orthopaedic surgery. Anaesthesia 1998; 53 Suppl 2:1-3. [PMID: 9659040 DOI: 10.1111/j.1365-2044.1998.tb15128.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- G Ihra
- Department of Anesthesiology and General Intensive Care Medicine, University of Vienna, Austria
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Grasl MC, Donner A, Schragl E, Aloy A. Tubeless laryngotracheal surgery in infants and children via jet ventilation laryngoscope. Laryngoscope 1997; 107:277-81. [PMID: 9023256 DOI: 10.1097/00005537-199702000-00024] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
We present the first use of tubeless superimposed combined high- and low-frequency jet ventilation (SHFJV) with a jet laryngoscope in laryngotracheal surgery in infants and children. Twenty-eight patients underwent 53 operative procedures. The average age of the patients was 7.3 years. The most common diagnoses were laryngeal papillomatosis and subglottic stenosis. The duration of jet ventilation averaged 33 min. The gas exchange was sufficient in each case. The advantages of SHFJV in the surgery of the laryngotracheal area in infants and children are optimal view at the larynx and trachea, maximum space for the handling, application of the laser without risks, no time limitation, suitability for stenosis, and neither anesthetic nor surgical complications.
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Affiliation(s)
- M C Grasl
- Department of Otorhinolaryngology, University of Vienna, Austria
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Ihra S, Kolev N, Donner A, Aloy A. A.68 Superimposed high-frequency jet-ventilation and its effects on left ventricular systolic function assessed by transoesophageal echocardiography. Br J Anaesth 1996. [DOI: 10.1016/s0007-0912(18)30923-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
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Kommentar zur Arbeit “Endoluminale Schienung (Stenting) bei Stenosen des Tracheobronchialsystems”. ACTA ACUST UNITED AC 1991. [DOI: 10.1007/bf02658867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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