High frequency positive pressure jet ventilation in bilateral bronchopleural fistulae

Derderian, Sarkis S.; Rajagopal, Krishnan R.; Abbrecht, Peter H.; Bennett, Leo L.; Doblar, Dennis D.; Hunt, Keith K.

doi:10.1097/00003246-198202000-00012

Cited by 44 publications

(6 citation statements)

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“…Because it consistently produces lower peak airway pressures, the use of HFJV is theoretically appealing in patients with central fistulae and has been used with success in patients with disrupted proximal airways [34][35][36] Taken together, however, the literature on HFJV in patients with BPF and PPF provides mixed results. 25,[37][38][39][40][41][42][43][44] While HFJV provided lower peak airway pressures than conventional ventilation, this did not consistently translate into a decrease in mean airway pressure or air leak. 25,[41][42][43][44] Similarly, there are case reports of improved CO 2 excretion and oxygen saturation following initiation of HFJV, [37][38][39][40] but in a series of consecutive patients with PPF and BPF, changing from conventional ventilation to HFJV resulted in a marked increase in hypoxemia in six of seven patients.…”

Section: Alternative Ventilator Strategiesmentioning

confidence: 99%

Persistent Air Leaks in Patients Receiving Mechanical Ventilation

Kempainen

Pierson²

2001

Seminars in Respiratory and Critical Care Medicine

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The term bronchopleural fistula (BPF) can be loosely defined as persistent leakage of gas from the airways into the pleural space. A true BPF, however, is located in the central airways, whereas leaks located peripherally are better described by the term parenchymal-pleural fistula (PPF). The presence of a persistent leak in a mechanically ventilated patient is a worrisome prognostic sign independent of the precise origin, yet it is important to distinguish BPF from PPF in this population. Fundamental differences in the pathogenesis and natural history of these two entities dictate divergent approaches to management. This review compares and contrasts the evaluation and management of BPF and PPF in patients receiving mechanical ventilation, and provides an overview of the many nonsurgical interventions used to manage persistent leaks.

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Section: Alternative Ventilator Strategiesmentioning

confidence: 99%

Persistent Air Leaks in Patients Receiving Mechanical Ventilation

Kempainen

Pierson²

2001

Seminars in Respiratory and Critical Care Medicine

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“…HFJV has been utilized by some clinicians in patients with BPF failing conventional therapy [206–210]. The two case series comparing the use of HFJV with conventional ventilation, however, have reported disappointing results.…”

Section: Pleural Effusions In the Icumentioning

confidence: 99%

Pleural Disease in the Intensive Care Unit

Jantz¹,

Sahn²

2000

J Intensive Care Med

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Pleural disease itself is an unusual cause for admission to the intensive care unit (ICU). Pleural complications of diseases and procedures in the ICU are common, however, and the impact on respiratory physiology is additive to that of the underlying cardiopulmonary disease. Pleural effusion and pneumothorax may be overlooked in the critically ill patient due to alterations in radiologic appearance in the supine patient. The development of a pneumothorax in a patient in the ICU represents a potentially life‐threatening situation. This article reviews the etiologies, pathophysiology, and management of pleural effusion, pneumothorax, tension pneumothorax, and bronchopleural fistula in the critically ill patient. In addition, we review the potential complications of thoracentesis and chest tube thoracostomy, including reexpansion pulmonary edema.

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“…This latter approach may utilize (1) surgery, although it is rarely useful in barotrauma because the location of the parenchymal defect is usually unknown; (2) ventilatory techniques that minimize peak inspiratory, expiratory, or mean airway pressures so that tidal volume, PEEP, inspiratory gas flow rates, and ventilator frequency are minimized and inspiratory plateau or reversal of inspiratory: expiratory ratio techniques are avoided [53]; high frequency jet or oscillatory methods [54,55] have also been successfully applied to reduce airway pressure and gas flow through a bpf; (3) increasing or decreasing suction applied to the chest tube to reduce the pressure gradient between the airway and pleural space [49,56]; (4) obstruction of the airway leading to the bpf through use of balloons [57], tissue glue [58], cautery, weights of various types, radium implants [53,59], or carbon dioxide laser [60]; and (5) equalizing airway and pleural pressures across the bpf during inspiration or exhalation by using PEEP or exhalation valves applied to the chest tube [53,59,61]. Air Entry into Blood Vessels.…”

Section: Mechanisms Of Injurymentioning

confidence: 99%

Pulmonary Barotrauma in the Intensive Care Unit

Powner

1988

J Intensive Care Med

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Disruption of lung parenchyma by airway gas (baro trauma) frequently occurs in the intensive care unit. Gas may move from the airspace into several abnormal loca tions as a result of dissection along anatomical fascial planes to potentially produce interstitial emphysema, subpleural cysts, pneumomediastinum, subcutaneous emphysema, pneumopericardium, pneumothorax, pneu moperitoneum, pneumoretroperitoneum, bronchopleu ral fistulas, and air-entry into blood vessels. Although usually of limited clinical consequence, this extra-alve olar air may produce clinically significant morbidity and mortality. Recognition of these potential complications of pulmonary disease and its therapy may assist the clini cian in correctly diagnosing, avoiding, and treating the manifestations of pulmonary barotrauma.

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High frequency positive pressure jet ventilation in bilateral bronchopleural fistulae

Cited by 44 publications

References 0 publications

Persistent Air Leaks in Patients Receiving Mechanical Ventilation

Persistent Air Leaks in Patients Receiving Mechanical Ventilation

Pleural Disease in the Intensive Care Unit

Pulmonary Barotrauma in the Intensive Care Unit

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