High frequency percutaneous transtracheal jet ventilation

Objective: To describe our experience with superimposed high-frequency jet ventilation (SHFJV), which does not require any endotracheal tubes or catheters, for performing laryngeal and tracheal surgery.Design: A case series of 500 patients.Setting: A university medical center.Patients: Four hundred sixty adult patients and 40 children in a consecutive sample who required laryngeal or tracheal surgery under SHFJV.Interventions: The SHFJV uses 2 jet streams with different frequencies simultaneously and is applied using a jet laryngoscope. Ventilation was performed with an airoxygen mixture, and intravenous agents were used for anesthesia. Arterial blood gas values were analyzed. Main Outcome Measures:Reported values of oxygenation and ventilation during the application of SHFJV and laryngotracheal surgery.Results: In 497 patients, adequate oxygenation with a mean ± SD PaO 2 of 91.8 ± 22.9 mm Hg and ventilation with a PaCO 2 of 29.7 ± 5.5 mm Hg were achieved using SHFJV. The average duration of the application of ventilation was 27 minutes, and the longest duration was 118 minutes. No complications due to the ventilation technique were observed. Laser surgery was performed in 150 patients.

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“…This further enhances the tidal volume but also results in a decreased applied oxygen concentration, as noted by the adjusted FIO 2 …”

Section: Anesthesia Techniquementioning

confidence: 99%

“…1 Initially, the gas used for ventilation was applied transtracheally or translaryngeally, with the insertion of thin metal cannulas, probes, or catheters. 2 A further step in achieving adequate ventilation without limiting visibility is the superimposed high-frequency jet ventilation (SHFJV), which was developed in 1990 by Aloy et al 3 …”

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confidence: 99%

Superimposed High-Frequency Jet Ventilation for Laryngeal and Tracheal Surgery

Lanzenberger-Schragl

Donner²,

Grasl³

et al. 2000

Arch Otolaryngol Head Neck Surg

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“…The literature which has examined the effect of HFJV on car diac output has demonstrated various re sults [1,9,10,13,18], with the consensus indicating little effect. These studies, how ever, have utilized techniques which aver age cardiac output over several beats.…”

Section: Discussionmentioning

confidence: 99%

Oscillatory Cardiopulmonary Effects of High-Frequency Jet Ventilation

Gotshall¹,

Miles²,

Sexson³

et al. 1986

Respiration

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The cardiovascular effects of high-frequency jet ventilation (HFJV) were compared with conventional volume ventilation in the anesthetized dog. A unique effect of HFJV on stroke volume and cardiac output was observed when stroke volume was analyzed on a beat-by-beat basis with impedance cardiography. A pronounced amplitude modulation of stroke volume, as well as of pulmonary and arterial pressure, occurred when the frequency of the HFJV approached the heart rate. The beat frequency of these amplitude oscillations was equal to that predicted based upon the frequency of the HFJV and the heart rate. Cardiac outputs obtained by techniques which average several beats will not detect these oscillations in cardiac output. These findings suggest that HFJV can generate an oscillation in thoracic hemodynamics which affects ventricular output in a similar manner.

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“…Ravussin and Freeman [5] described a transtracheal catheter with two side holes to reduce distal pressure and a curve to hold the tip off the mucosa. In contrast, Klain and Smith [6] reported no mucosal damage in dogs using high pressure jet ventilation for 50 h via a 16 G angiocath. More recent reviews and editorials have not considered mucosal penetration by the catheter itself significant [1,7].…”

Section: Introductionmentioning

confidence: 92%

Cricothyroidotomy catheters: an investigation of mechanisms of failure and the effect of a novel intracatheter stylet

2015

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SummaryEmergency catheter cricothyroidotomy often fails. Case reports have concentrated on kinking and displacement of the catheter as the major causes. We investigated catheter tip penetration of the trachea. Using insertion angles of 90°, 75°, 60°, 45°and 30°we advanced 14 G intravenous catheters into fresh isolated sheep tracheas during high pressure oxygen insufflation. At all angles, the catheter tip became blocked by pushing into the mucosa with submucosal gas injection on one or more attempts. Full thickness rupture with extratracheal gas also occurred on insertions at 90°and 60°. We then tested a Luer-mounted prototype wire stylet which remains in situ during insufflation. Using the same methodology, the stylet was able to be placed and prevented blockage at all angles of insertion. Mucosal trauma and submucosal gas injection occurred on insertions at 90°and 75°. Our results should guide further stylet design.

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High frequency percutaneous transtracheal jet ventilation

Cited by 223 publications

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Superimposed High-Frequency Jet Ventilation for Laryngeal and Tracheal Surgery

Superimposed High-Frequency Jet Ventilation for Laryngeal and Tracheal Surgery

Oscillatory Cardiopulmonary Effects of High-Frequency Jet Ventilation

Cricothyroidotomy catheters: an investigation of mechanisms of failure and the effect of a novel intracatheter stylet

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