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Sütterlin R, Galmén K, Harbut P. Comment on "Recovery and safety with prolonged high-frequency jet ventilation for catheter ablation of atrial fibrillation: A hospital registry study from a New England healthcare network". J Clin Anesth 2024; 96:111503. [PMID: 38810300 DOI: 10.1016/j.jclinane.2024.111503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2024] [Revised: 04/18/2024] [Accepted: 05/15/2024] [Indexed: 05/31/2024]
Affiliation(s)
- Robert Sütterlin
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden.
| | - Karolina Galmén
- Karolinska Institute Department of Clinical Sciences, Danderyd Hospital, Stockholm, Sweden
| | - Piotr Harbut
- Karolinska Institute Department of Clinical Sciences, Danderyd Hospital, Stockholm, Sweden
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LoMauro A, De Luca A, Scarpazza P, Aliverti A. In Vivo Measurement of Tidal Volume During Non-invasive Respiratory Support by Continuous-Flow Helmet CPAP. Ann Biomed Eng 2024; 52:2546-2555. [PMID: 38886251 PMCID: PMC11329575 DOI: 10.1007/s10439-024-03545-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2024] [Accepted: 05/08/2024] [Indexed: 06/20/2024]
Abstract
Recently, the interest in the Helmet interface during non-invasive respiratory support (NIRS) has increased due to the COVID-19 pandemic. During NIRS, positive end-expiratory pressure (PEEP) can be given as continuous positive airway pressure (CPAP), which maintains a positive airway pressure throughout the whole respiratory cycle with Helmet as an interface (H-CPAP). The main disadvantage of the H-CPAP is the inability to measure tidal volume (VT). Opto-electronic plethysmography (OEP) is a non-invasive technique that is not sensitive to gas compression/expansion inside the helmet. OEP acquisitions were performed on 28 healthy volunteers (14 females and 14 males) at baseline and during Helmet CPAP. The effect of posture (semi-recumbent vs. prone), flow (50 vs. 60 L/min), and PEEP (0 vs. 5 vs. 10 cmH2O) on the ventilatory and thoracic-abdominal pattern and the operational volumes were investigated. Prone position limited vital capacity, abdominal expansion and chest wall recruitment. A constant flow of 60 L/min reduced the need for the subject to ventilate while having a slight recruitment effect (100 mL) in the semi-recumbent position. A progressive increasing recruitment was found with higher PEEP but limited by the prone position. It is possible to accurately measure tidal volume during H-CPAP to deliver non-invasive ventilatory support using opto-electronic plethysmography during different clinical settings.
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Affiliation(s)
- A LoMauro
- Dipartimento di Elettronica, Informazione e Bioingegneria, Politecnico di Milano, P.zza L. da Vinci, 32, 20133, Milan, Italy.
| | - A De Luca
- Dipartimento di Elettronica, Informazione e Bioingegneria, Politecnico di Milano, P.zza L. da Vinci, 32, 20133, Milan, Italy
| | - P Scarpazza
- Pneumology Unit, Ospedale Civile, Vimercate, Milan, Italy
| | - A Aliverti
- Dipartimento di Elettronica, Informazione e Bioingegneria, Politecnico di Milano, P.zza L. da Vinci, 32, 20133, Milan, Italy
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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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Graur A, Mercaldo ND, Simon J, Alici C, Saenger JA, Cahalane AM, Vazquez R, Fintelmann FJ. High-Frequency Jet Ventilation Versus Spontaneous Respiration for Percutaneous Cryoablation of Lung Tumors: Comparison of Adverse Events and Procedural Efficiency. AJR Am J Roentgenol 2024; 222:e2330557. [PMID: 38264999 DOI: 10.2214/ajr.23.30557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2024]
Abstract
BACKGROUND. High-frequency jet ventilation (HFJV) facilitates accurate probe placement in percutaneous ablation of lung tumors but may increase risk for adverse events, including systemic air embolism. OBJECTIVE. The purpose of this study was to compare major adverse events and procedural efficiency of percutaneous lung ablation with HFJV under general anesthesia to spontaneous respiration (SR) under moderate sedation. METHODS. This retrospective study included consecutive adults who underwent CT-guided percutaneous cryoablation of one or more lung tumors with HFJV or SR between January 1, 2017, and May 31, 2023. We compared major adverse events (Common Terminology Criteria for Adverse Events grade ≥ 3) within 30 days postprocedure and hospital length of stay (HLOS) of 2 days or more using logistic regression analysis. We compared procedure time, room time, CT guidance acquisition time, CT guidance radiation dose, total radiation dose, and pneumothorax using generalized estimating equations. RESULTS. Overall, 139 patients (85 women, 54 men; median age, 68 years) with 310 lung tumors (82% metastases) underwent 208 cryoablations (HFJV, n = 129; SR, n = 79). HFJV showed greater rates than SR for the treatment of multiple tumors per session (43% vs 19%, respectively; p = .02) and tumors in a nonperipheral location (48% vs 24%, p < .001). Major adverse event rate was 8% for HFJV and 5% for SR (p = .46). No systemic air embolism occurred. HLOS was 2 days or more in 17% of sessions and did not differ significantly between HFJV and SR (p = .64), including after adjusting for probe number per session, chronic obstructive pulmonary disease, and operator experience (p = .53). Ventilation modalities showed no significant difference in procedure time, CT guidance acquisition time, CT guidance radiation dose, or total radiation dose (all p > .05). Room time was longer for HFJV than SR (median, 154 vs 127 minutes, p < .001). For HFJV, the median anesthesia time was 136 minutes. Ventilation modalities did not differ in the frequencies of pneumothorax or pneumothorax requiring chest tube placement (both p > .05). CONCLUSION. HFJV appears to be as safe as SR but had longer room times. HFJV can be used in complex cases without significantly impacting HLOS of 2 days or more, procedure time, or radiation exposure. CLINICAL IMPACT. Selection of the ventilation modality during percutaneous lung ablation should be based on patient characteristics and anticipated procedural requirements as well as operator preference.
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Affiliation(s)
- Alexander Graur
- Department of Radiology, Division of Thoracic Imaging and Intervention, Massachusetts General Hospital, 55 Fruit St, Boston, MA 02114
- Department of Radiology, Ludwig-Maximilians-University, Munich, Germany
| | | | - Judit Simon
- Department of Radiology, Division of Thoracic Imaging and Intervention, Massachusetts General Hospital, 55 Fruit St, Boston, MA 02114
| | - Cagatay Alici
- Department of Radiology, Division of Thoracic Imaging and Intervention, Massachusetts General Hospital, 55 Fruit St, Boston, MA 02114
| | - Jonathan A Saenger
- Department of Radiology, Division of Thoracic Imaging and Intervention, Massachusetts General Hospital, 55 Fruit St, Boston, MA 02114
- Department of Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Alexis M Cahalane
- Department of Radiology, Division of Thoracic Imaging and Intervention, Massachusetts General Hospital, 55 Fruit St, Boston, MA 02114
| | - Rafael Vazquez
- Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital, Boston, MA
| | - Florian J Fintelmann
- Department of Radiology, Division of Thoracic Imaging and Intervention, Massachusetts General Hospital, 55 Fruit St, Boston, MA 02114
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Lesser T, Wolfram F, Braun C, Gottschall R. Effects of unilateral superimposed high-frequency jet ventilation on porcine hemodynamics and gas exchange during one-lung flooding. World J Exp Med 2024; 14:87256. [PMID: 38590298 PMCID: PMC10999063 DOI: 10.5493/wjem.v14.i1.87256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Revised: 11/30/2023] [Accepted: 12/29/2023] [Indexed: 03/19/2024] Open
Abstract
BACKGROUND Superimposed high-frequency jet ventilation (SHFJV) is suitable for respiratory motion reduction and essential for effective lung tumor ablation. Fluid filling of the target lung wing one-lung flooding (OLF) is necessary for therapeutic ultrasound applications. However, whether unilateral SHFJV allows adequate hemodynamics and gas exchange is unclear. AIM To compared SHFJV with pressure-controlled ventilation (PCV) during OLF by assessing hemodynamics and gas exchange in different animal positions. METHODS SHFJV or PCV was used alternatingly to ventilate the non-flooded lungs of the 12 anesthetized pigs during OLF. The animal positions were changed from left lateral position to supine position (SP) to right lateral position (RLP) every 30 min. In each position, ventilation was maintained for 15 min in both modalities. Hemodynamic variables and arterial blood gas levels were repeatedly measured. RESULTS Unilateral SHFJV led to lower carbon dioxide removal than PCV without abnormally elevated carbon dioxide levels. SHFJV slightly decreased oxygenation in SP and RLP compared with PCV; the lowest values of PaO2 and PaO2/FiO2 ratio were found in SP [13.0; interquartile range (IQR): 12.6-5.6 and 32.5 (IQR: 31.5-38.9) kPa]. Conversely, during SHFJV, the shunt fraction was higher in all animal positions (highest in the RLP: 0.30). CONCLUSION In porcine model, unilateral SHFJV may provide adequate ventilation in different animal positions during OLF. Lower oxygenation and CO2 removal rates compared to PCV did not lead to hypoxia or hypercapnia. SHFJV can be safely used for lung tumor ablation to minimize ventilation-induced lung motion.
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Affiliation(s)
- Thomas Lesser
- Department of Thoracic and Vascular Surgery, SRH Wald Klinikum Gera, Gera D-07548, Germany
| | - Frank Wolfram
- Department of Thoracic and Vascular Surgery, SRH Wald Klinikum Gera, Gera D-07548, Germany
| | - Conny Braun
- Central Experimental Animal Facility, Jena University Hospital, Jena 07743, Germany
| | - Reiner Gottschall
- Department of Anaesthesiology and Intensive Care, Jena University Hospital, Jena 07747, Germany
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Zhou Y, Peng J, Zhu W, Ke Y, Shan L. Clinical study of multifunctional laryngeal mask in airway interventional therapy. Medicine (Baltimore) 2022; 101:e31388. [PMID: 36397451 PMCID: PMC9666165 DOI: 10.1097/md.0000000000031388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE This study is conducted to evaluate the efficacy and safety of using multifunctional intubation laryngeal masks with normal frequency jet ventilation in airway interventional therapy. METHODS A total of 200 patients receiving airway interventional therapy were enrolled in this retrospective study and were divided into 2 groups (group M and group P) by doctors in our hospital to compare the effect of different laryngeal masks. Group M used common laryngeal masks and an anesthesia machine for positive pressure ventilation while group P took multifunctional intubation laryngeal masks and used a jet ventilator for normal frequency jet ventilation. The patients' mean arterial pressure, heart rate, arterial oxygen partial pressure (PaO2) and arterial carbon dioxide partial pressure (PaCO2), and the operation time, recovery score and the patients' and doctors' satisfaction levels were compared between the 2 groups. RESULTS Both groups were hemodynamically stable, and their PaO2 levels were significantly higher before the operation than that during and after the operation (P < .05). Compared with group M, the PaCO2 level of group P was more stable both during and after the operation, and this difference was statistically significant (P < .05). There was no statistically significant difference in terms of the 2 group's operating time, recovery score, and patients' satisfaction levels (P > .05). However, the satisfaction levels of doctors in group P were higher than that in group M, and this difference was statistically significant (P < .05). CONCLUSION As statistics show, the intraoperative hemodynamics and PaO2 and PaCO2 levels were stable, and patients, surgeons and anesthesia operators were satisfied. Therefore, it is feasible to apply multifunctional intubation laryngeal masks with normal frequency jet ventilation in airway interventional therapy and it is a safe and ideal way to ensure ventilation.
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Affiliation(s)
- Yuan Zhou
- Department of Anesthesiology, The Second Affiliated Hospital of Xiamen Medical College, Xiamen, P.R. China
| | - Jianliang Peng
- Department of Anesthesiology, The Second Affiliated Hospital of Xiamen Medical College, Xiamen, P.R. China
| | - Wujian Zhu
- Department of Anesthesiology, The Second Affiliated Hospital of Xiamen Medical College, Xiamen, P.R. China
| | - Yazhen Ke
- Department of Anesthesiology, The Second Affiliated Hospital of Xiamen Medical College, Xiamen, P.R. China
| | - Ligang Shan
- Department of Anesthesiology, The Second Affiliated Hospital of Xiamen Medical College, Xiamen, P.R. China
- *Correspondence: Ligang Shan, Department of Anesthesiology, The Second Affiliated Hospital of Xiamen Medical College, Xiamen, Fujian Province 361021, P.R. China (e-mail: )
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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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LoMauro A, Aliverti A, Perchiazzi G, Frykholm P. Physiological changes and compensatory mechanisms by the action of respiratory muscles in a porcine model of phrenic nerve injury. J Appl Physiol (1985) 2021; 130:813-826. [PMID: 33444121 DOI: 10.1152/japplphysiol.00781.2020] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
Phrenic nerve damage may occur as a complication of specific surgical procedures, prolonged mechanical ventilation, or physical trauma. The consequent diaphragmatic paralysis or dysfunction can lead to major complications. The purpose of this study was to elucidate the role of the nondiaphragmatic respiratory muscles during partial or complete diaphragm paralysis induced by unilateral and bilateral phrenic nerve damage at different levels of ventilatory pressure support in an animal model. Ten pigs were instrumented, the phrenic nerve was exposed from the neck, and spontaneous respiration was preserved at three levels of pressure support, namely, high, low, and null, at baseline condition, after left phrenic nerve damage, and after bilateral phrenic nerve damage. Breathing pattern, thoracoabdominal volumes and asynchrony, and pressures were measured at each condition. Physiological breathing was predominantly diaphragmatic and homogeneously distributed between right and left sides. After unilateral damage, the paralyzed hemidiaphragm was passively dragged by the ipsilateral rib cage muscles and the contralateral hemidiaphragm. After bilateral damage, the drive to and the work of breathing of rib cage and abdominal muscles increased, to compensate for diaphragmatic paralysis, ensuing paradoxical thoracoabdominal breathing. Increasing level of pressure support ventilation replaces this muscle group compensation. When the diaphragm is paralyzed (unilaterally and/or bilaterally), there is a coordinated reorganization of nondiaphragmatic respiratory muscles as compensation that might be obscured by high level of pressure support ventilation. Noninvasive thoracoabdominal volume and asynchrony assessment could be useful in phrenic nerve-injured patients to estimate the extent and type of inspiratory muscle dysfunction.NEW & NOTEWORTHY This was the first (to our knowledge) implanted porcine model of phrenic nerve injury with a detailed multidimensional analysis of different degrees of diaphragmatic paralysis (unilateral and bilateral). Noninvasive thoracoabdominal volume and asynchrony assessment was shown to be useful in estimating the extent of diaphragmatic dysfunction and the consequent coordinated reorganization of nondiaphragmatic respiratory muscles. High level of pressure support ventilation was proved to obscure the interaction and compensation of respiratory muscles to deal with phrenic nerve injury.
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Affiliation(s)
- Antonella LoMauro
- Dipartimento di Elettronica, Informazione e Bioingegneria, Politecnico di Milano, Milan, Italy.,Section of Anaesthesiology and Intensive Care, Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - Andrea Aliverti
- Dipartimento di Elettronica, Informazione e Bioingegneria, Politecnico di Milano, Milan, Italy
| | - Gaetano Perchiazzi
- Section of Anaesthesiology and Intensive Care, Department of Surgical Sciences, Uppsala University, Uppsala, Sweden.,Hedenstierna Laboratory, Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - Peter Frykholm
- Section of Anaesthesiology and Intensive Care, Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
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Comparison of different methods for lung immobilization in an animal model. Radiother Oncol 2020; 150:151-158. [PMID: 32580000 DOI: 10.1016/j.radonc.2020.06.024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Revised: 05/28/2020] [Accepted: 06/17/2020] [Indexed: 12/25/2022]
Abstract
BACKGROUND AND PURPOSE Respiratory-induced motion introduces uncertainties in the delivery of dose in radiotherapy treatments. Various methods are used clinically, e.g. breath-holding, while there is limited experience with other methods such as apneic oxygenation and high frequency jet ventilation (HFJV). This study aims to compare the latter approaches for lung immobilization and their clinical impact on gas exchange in an animal model. MATERIALS AND METHODS Two radiopaque tumor surrogate markers (TSM) were placed in the central (cTSM) and peripheral (dTSM) regions of the lungs in 9 anesthetized and muscle relaxed pigs undergoing 3 ventilatory interventions (1) HFJV at rates of 200 (JV200), 300 (JV300) and 400 (JV400) min-1; (2) apnea at continuous positive airway pressure (CPAP) levels of 0, 8 and 16 cmH2O; (3) conventional mechanical ventilation (CMV) as reference mode. cTSM and dTSM were visualized using fluoroscopy and their coordinates were computed. The ventilatory pattern was registered, and oxygen and carbon dioxide (pCO2) partial pressures were measured. RESULTS The highest range of TSM motion, and ventilation was found during CMV, the lowest during apnea. During HFJV the amount of motion varied inversely with increasing frequency. The reduction of TSM motion at JV300, JV400 and all CPAP levels came at the cost of increased pCO2, however the relatively low frequency of 200 min-1 for HFJV was the only ventilatory setting that enabled adequate CO2 removal. CONCLUSION In this model, HFJV at 200 min-1 was the best compromise between immobilization and gas exchange for sessions of 10-min duration.
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Galmén K, Jakobsson JG, Freedman J, Harbut P. High Frequency Jet Ventilation during stereotactic ablation of liver tumours: an observational study on blood gas analysis as a measure of lung function during general anaesthesia. F1000Res 2019; 8:386. [PMID: 31583085 PMCID: PMC6753604 DOI: 10.12688/f1000research.18369.1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/01/2019] [Indexed: 11/20/2022] Open
Abstract
Background: Stereotactic ablation of tumours in solid organs is a promising curative procedure in clinical oncology. The technique demands minimal target organ movements to optimise tumour destruction and prevent injury to surrounding tissues. High frequency jet ventilation (HFJV) is a novel option during these procedures, reducing the respiratory-associated movements of the liver. The effects of HFJV via endotracheal catheter on gas exchange during liver tumour ablation is not well studied. Methods: The aim of this explorative study was to assess lung function and the effects on blood gas and lactate during HFJV in patients undergoing stereotactic liver ablation. Blood gases were analysed in 25 patients scheduled for stereotactic liver ablation under general anaesthesia pre-induction, every 15 minutes during HFJV and following extubation in the recovery room. The HFJV was set at fixed settings. Results: None of the patients developed hypoxia or signs of increased lactate production but a great variation in PaO 2/FiO 2 ratio was found; from 13.1 to 71.3. An increase in mean PaCO 2 was observed, from a baseline of 5.0 to a peak of 7.1 at 30 minutes (p <0.001) and a decrease was found in median pH, from a baseline of 7.44 to 7.31 at 15 minutes (p=0.03). We could not see any clear association between a decrease in PaO 2/FiO 2 ratio and PaCO 2 elevation. Conclusions: HFJV during general anaesthesia in patients undergoing stereotactic liver ablation is feasible and it did not cause hypoxemia or signs of increased lactate production. A reversible mild to moderate impairment of gas exchange was found during HFJV.
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Affiliation(s)
- Karolina Galmén
- Department of Anaesthesia and Intensive Care, Institution for Clinical Sciences, Karolinska Institutet, Danderyd University Hospital, Stockholm, 182 88, Sweden
| | - Jan G Jakobsson
- Department of Anaesthesia and Intensive Care, Institution for Clinical Sciences, Karolinska Institutet, Danderyd University Hospital, Stockholm, 182 88, Sweden
| | - Jacob Freedman
- Department of Surgery, Institution for Clinical Sciences, Karolinska Institutet, Danderyd University Hospital, Stockholm, 182 88, Sweden
| | - Piotr Harbut
- Department of Anaesthesia and Intensive Care, Institution for Clinical Sciences, Karolinska Institutet, Danderyd University Hospital, Stockholm, 182 88, Sweden
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Hohenforst-Schmidt W, Zarogoulidis P, Huang H, Man YG, Laskou S, Koulouris C, Giannakidis D, Mantalobas S, Florou MC, Amaniti A, Steinheimer M, Sinha A, Freitag L, Turner JF, Browning R, Vogl T, Roman A, Benhassen N, Kesisoglou I, Sapalidis K. A New and Safe Mode of Ventilation for Interventional Pulmonary Medicine: The Ease of Nasal Superimposed High Frequency Jet Ventilation. J Cancer 2018; 9:816-833. [PMID: 29581760 PMCID: PMC5868146 DOI: 10.7150/jca.23737] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2017] [Accepted: 12/03/2017] [Indexed: 12/14/2022] Open
Abstract
We use pulmonary interventional procedures for the diagnosis of pulmonary diseases either for benign or malignant lesions. Flexible bronchoscopy with or without radial endobronchial ultrasound, convex-probe endobronchial ultrasound and electromagnetic navigation are procedures performed in centers with experience in diagnostic pulmonary medicine. The method of sedation and ventilation is very important in order to avoid or handle with success complications. Proper respiration during pulmonary (or other interventional) procedures is a key factor. Apart from the proper sedation method we have to choose the proper ventilation method which decides respiratory movement. Superimposed high-frequency jet ventilation (SHFJV) is supposed to be safe and effective in clinical practice. Although this perception is commonly accepted, there is no study proving its safety on the basic of reliable data. We analyzed the data of 100 patients in different interventional settings (bronchoscopy with or without navigational approach, left atrial appendage closure (LAAC) or intracardiac catheterization) using nasal SHFJV. Mainly analyzed were capillary ABG-Data at the beginning and end of the intervention under sedation. The aim was to analyze if a risk scenario for the patient by using the nasal SHFJV can be derived by measuring the changes of pCO2, pO2, cBase Excess, cHCO3 and PH. Due to our data we conclude that this method of ventilation can be easily and safely used in interventional medicine for patients with all kind of comorbidities such as; chronic respiratory disease, lung cancer, interstitial lung disease, structural heart disease and heart failure.
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Affiliation(s)
- Wolfgang Hohenforst-Schmidt
- Sana Clinic Group Franken, Department of Cardiology / Pulmonology / Intensive Care / Nephrology, ''Hof'' Clinics, University of Erlangen, Hof, Germany
| | - Paul Zarogoulidis
- Pulmonary-Oncology Department, ``Theageneio`` Cancer Hospital, Thessaloniki, Greece
| | - Haidong Huang
- Department of Respiratory Diseases Shanghai Hospital, II Military University Hospital, Shanghai, People's Republic of China
| | - Yan-Gao Man
- Research Laboratory and International Collaboration, Bon Secours Cancer Institute, VA, USA
| | - Stella Laskou
- Sana Clinic Group Franken, Department of Cardiology / Pulmonology / Intensive Care / Nephrology, ''Hof'' Clinics, University of Erlangen, Hof, Germany.,Pulmonary-Oncology Department, ``Theageneio`` Cancer Hospital, Thessaloniki, Greece.,Department of Respiratory Diseases Shanghai Hospital, II Military University Hospital, Shanghai, People's Republic of China.,Research Laboratory and International Collaboration, Bon Secours Cancer Institute, VA, USA.,3rd Department of Surgery, "AHEPA" University Hospital, Aristotle University of Thessaloniki, Medical School, Thessaloniki, Greece.,Anesthesiology Department, "AHEPA" University General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece.,Department of Interventional Pneumology, Ruhrlandklinik, University Hospital Essen, University of Essen-Duisburg, Tueschener Weg 40, 45239 Essen, Germany.,Division of Interventional Pulmonology & Medical Oncology, Cancer Treatment Centers of America, Western Regional Medical Center, Goodyear, AZ.,Pulmonary & Critical Care Medicine, Interventional Pulmonology, National Naval Medical Center, Walter Reed Army Medical Center, Bethesda, U.S.A.,Department of Diagnostic and Interventional Radiology, Goethe University of Frankfurt, Frankfurt, Germany.,Medical Clinic I, "Fuerth" Hospital, University of Erlangen, Fuerth, Germany
| | - Charilaos Koulouris
- Sana Clinic Group Franken, Department of Cardiology / Pulmonology / Intensive Care / Nephrology, ''Hof'' Clinics, University of Erlangen, Hof, Germany.,Pulmonary-Oncology Department, ``Theageneio`` Cancer Hospital, Thessaloniki, Greece.,Department of Respiratory Diseases Shanghai Hospital, II Military University Hospital, Shanghai, People's Republic of China.,Research Laboratory and International Collaboration, Bon Secours Cancer Institute, VA, USA.,3rd Department of Surgery, "AHEPA" University Hospital, Aristotle University of Thessaloniki, Medical School, Thessaloniki, Greece.,Anesthesiology Department, "AHEPA" University General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece.,Department of Interventional Pneumology, Ruhrlandklinik, University Hospital Essen, University of Essen-Duisburg, Tueschener Weg 40, 45239 Essen, Germany.,Division of Interventional Pulmonology & Medical Oncology, Cancer Treatment Centers of America, Western Regional Medical Center, Goodyear, AZ.,Pulmonary & Critical Care Medicine, Interventional Pulmonology, National Naval Medical Center, Walter Reed Army Medical Center, Bethesda, U.S.A.,Department of Diagnostic and Interventional Radiology, Goethe University of Frankfurt, Frankfurt, Germany.,Medical Clinic I, "Fuerth" Hospital, University of Erlangen, Fuerth, Germany
| | - Dimitris Giannakidis
- Sana Clinic Group Franken, Department of Cardiology / Pulmonology / Intensive Care / Nephrology, ''Hof'' Clinics, University of Erlangen, Hof, Germany.,Pulmonary-Oncology Department, ``Theageneio`` Cancer Hospital, Thessaloniki, Greece.,Department of Respiratory Diseases Shanghai Hospital, II Military University Hospital, Shanghai, People's Republic of China.,Research Laboratory and International Collaboration, Bon Secours Cancer Institute, VA, USA.,3rd Department of Surgery, "AHEPA" University Hospital, Aristotle University of Thessaloniki, Medical School, Thessaloniki, Greece.,Anesthesiology Department, "AHEPA" University General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece.,Department of Interventional Pneumology, Ruhrlandklinik, University Hospital Essen, University of Essen-Duisburg, Tueschener Weg 40, 45239 Essen, Germany.,Division of Interventional Pulmonology & Medical Oncology, Cancer Treatment Centers of America, Western Regional Medical Center, Goodyear, AZ.,Pulmonary & Critical Care Medicine, Interventional Pulmonology, National Naval Medical Center, Walter Reed Army Medical Center, Bethesda, U.S.A.,Department of Diagnostic and Interventional Radiology, Goethe University of Frankfurt, Frankfurt, Germany.,Medical Clinic I, "Fuerth" Hospital, University of Erlangen, Fuerth, Germany
| | - Stylianos Mantalobas
- Sana Clinic Group Franken, Department of Cardiology / Pulmonology / Intensive Care / Nephrology, ''Hof'' Clinics, University of Erlangen, Hof, Germany.,Pulmonary-Oncology Department, ``Theageneio`` Cancer Hospital, Thessaloniki, Greece.,Department of Respiratory Diseases Shanghai Hospital, II Military University Hospital, Shanghai, People's Republic of China.,Research Laboratory and International Collaboration, Bon Secours Cancer Institute, VA, USA.,3rd Department of Surgery, "AHEPA" University Hospital, Aristotle University of Thessaloniki, Medical School, Thessaloniki, Greece.,Anesthesiology Department, "AHEPA" University General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece.,Department of Interventional Pneumology, Ruhrlandklinik, University Hospital Essen, University of Essen-Duisburg, Tueschener Weg 40, 45239 Essen, Germany.,Division of Interventional Pulmonology & Medical Oncology, Cancer Treatment Centers of America, Western Regional Medical Center, Goodyear, AZ.,Pulmonary & Critical Care Medicine, Interventional Pulmonology, National Naval Medical Center, Walter Reed Army Medical Center, Bethesda, U.S.A.,Department of Diagnostic and Interventional Radiology, Goethe University of Frankfurt, Frankfurt, Germany.,Medical Clinic I, "Fuerth" Hospital, University of Erlangen, Fuerth, Germany
| | - Maria C Florou
- 3rd Department of Surgery, "AHEPA" University Hospital, Aristotle University of Thessaloniki, Medical School, Thessaloniki, Greece
| | - Aikaterini Amaniti
- Anesthesiology Department, "AHEPA" University General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Michael Steinheimer
- Sana Clinic Group Franken, Department of Cardiology / Pulmonology / Intensive Care / Nephrology, ''Hof'' Clinics, University of Erlangen, Hof, Germany
| | - Anil Sinha
- Sana Clinic Group Franken, Department of Cardiology / Pulmonology / Intensive Care / Nephrology, ''Hof'' Clinics, University of Erlangen, Hof, Germany
| | - Lutz Freitag
- Department of Interventional Pneumology, Ruhrlandklinik, University Hospital Essen, University of Essen-Duisburg, Tueschener Weg 40, 45239 Essen, Germany
| | - J Francis Turner
- Division of Interventional Pulmonology & Medical Oncology, Cancer Treatment Centers of America, Western Regional Medical Center, Goodyear, AZ
| | - Robert Browning
- Pulmonary & Critical Care Medicine, Interventional Pulmonology, National Naval Medical Center, Walter Reed Army Medical Center, Bethesda, U.S.A
| | - Thomas Vogl
- Department of Diagnostic and Interventional Radiology, Goethe University of Frankfurt, Frankfurt, Germany
| | - Andrei Roman
- Department of Diagnostic and Interventional Radiology, Goethe University of Frankfurt, Frankfurt, Germany
| | - Naim Benhassen
- Medical Clinic I, "Fuerth" Hospital, University of Erlangen, Fuerth, Germany
| | - Isaak Kesisoglou
- 3rd Department of Surgery, "AHEPA" University Hospital, Aristotle University of Thessaloniki, Medical School, Thessaloniki, Greece
| | - Konstantinos Sapalidis
- 3rd Department of Surgery, "AHEPA" University Hospital, Aristotle University of Thessaloniki, Medical School, Thessaloniki, Greece
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12
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A new mode of ventilation for interventional pulmonology. A case with EBUS-TBNA and debulking. Respir Med Case Rep 2017; 23:38-42. [PMID: 29234593 PMCID: PMC5723371 DOI: 10.1016/j.rmcr.2017.11.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2017] [Revised: 11/26/2017] [Accepted: 11/27/2017] [Indexed: 12/23/2022] Open
Abstract
Lung cancer is still underdiagnosed mainly due to lack of symptoms. Most patients are diagnosed in a late stage where unfortunately only systematic therapy can be applied. Fortunately in the last five years several novel therapies and combinations have emerged. However; in certain situations local therapeutics modalities have to be applied in order to solve emergency problems as in the case that we will present. Convex-EBUS probe was used along with a novel method of ventilation which keeps PCO2 concentration satisfyingly low.
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13
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Jet Ventilation during Rigid Bronchoscopy in Adults: A Focused Review. BIOMED RESEARCH INTERNATIONAL 2016; 2016:4234861. [PMID: 27847813 PMCID: PMC5101361 DOI: 10.1155/2016/4234861] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/08/2016] [Revised: 09/19/2016] [Accepted: 10/05/2016] [Indexed: 12/02/2022]
Abstract
The indications for rigid bronchoscopy for interventional pulmonology have increased and include stent placements and transbronchial cryobiopsy procedures. The shared airway between anesthesiologist and pulmonologist and the open airway system, requiring specific ventilation techniques such as jet ventilation, need a good understanding of the procedure to reduce potentially harmful complications. Appropriate adjustment of the ventilator settings including pause pressure and peak inspiratory pressure reduces the risk of barotrauma. High frequency jet ventilation allows adequate oxygenation and carbon dioxide removal even in cases of tracheal stenosis up to frequencies of around 150 min−1; however, in an in vivo animal model, high frequency jet ventilation along with normal frequency jet ventilation (superimposed high frequency jet ventilation) has been shown to improve oxygenation by increasing lung volume and carbon dioxide removal by increasing tidal volume across a large spectrum of frequencies without increasing barotrauma. General anesthesia with a continuous, intravenous, short-acting agent is safe and effective during rigid bronchoscopy procedures.
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14
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Bradbury AG, Clutton RE. Are neuromuscular blocking agents being misused in laboratory pigs? Br J Anaesth 2016; 116:476-85. [PMID: 26934943 DOI: 10.1093/bja/aew019] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
The literature (2012-4) describing experimental pig surgery was reviewed to estimate the extent to which neuromuscular block (NMB) is used, to examine methods for ensuring unconsciousness, and to identify the rationale for use of NMB and establish the anaesthetist's training. In the first stage of a two-stage review, NMB use was estimated using Web of Knowledge to identify articles describing NMB during pig surgeries. In the second stage, PubMed and Google Scholar were used to increase the number of articles for determining measures taken to prevent accidental awareness during general anaesthesia (AAGA). The corresponding authors of screened articles were emailed four times to establish the reason for using NMB and the anaesthetists' backgrounds (medical, veterinary, or technical). The first search revealed NMB use in 80 of 411 (20%) studies. Of the 153 articles analysed in the second stage, two described strategies to reduce AAGA. Some (6%) papers did not provide information on anaesthetic doses; citations supporting anaesthetic efficacy were found in only 13. Five of 69 papers using inhalation agents measured end-tidal anaesthetic concentrations based on human, not porcine, minimal alveolar concentrations. The methods in 13% of articles reporting anaesthetic depth assessment were incomplete or questionable, or both; four described using somatic motor reflexes. Corresponding authors of 121 articles reported that the principal reason for NMB was improved 'surgical visualization' (26%). Medical or veterinary anaesthetists supervised anaesthesia in 70% of studies; non-anaesthetists provided NMB, unsupervised, in 23. Nine respondents prioritized experimental expediency over pig welfare. In laboratory pig studies, AAGA may be prevalent; reported details of its attempted prevention are woefully inadequate.
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Affiliation(s)
- A G Bradbury
- Wellcome Trust Critical Care Laboratory for Large Animals, Roslin Institute & Royal (Dick) School of Veterinary Studies, The University of Edinburgh, Roslin, Midlothian EH25 9RG, UK
| | - R E Clutton
- Wellcome Trust Critical Care Laboratory for Large Animals, Roslin Institute & Royal (Dick) School of Veterinary Studies, The University of Edinburgh, Roslin, Midlothian EH25 9RG, UK
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15
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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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16
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Efficacy of Superimposed High-frequency Jet Ventilation Applied to Variable Degrees of Tracheal Stenosis. Anesthesiology 2015; 123:747-9. [DOI: 10.1097/aln.0000000000000819] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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