Intermittent positive pressure ventilation and high frequency ventilation in dogs with experimental bronchopleural fistulae

Ultra—High-Frequency Jet Ventilation in a Bronchopleural Fistula Model

“…Although there has been controversy about the effect of high-frequency ventilation on cardiovascular stability, there is general agreement that it is beneficial in dealing with iatrogenic barotrauma and bronchopleural fistulas. [2][3][4] In large bronchopleural fistulas, gas delivered with CPPV bypasses the alveoli. The large fistula flow results in decreased carbon dioxide elimination, hypercarbia, and, ultimately, acidosis and hypoxemia.…”

Pleural Disease in the Intensive Care Unit

“…A number of studies comparing HFJV and HFOV with conventional ventilation using animal models have shown less BPF air flow during HFJV and HFOV [200–203], while one study using HFJV demonstrated no difference [204]. In studies reporting blood gases, improved oxygenation was seen during HFJV and HFOV compared with conventional ventilation [201–203,205]. Increasing levels of PEEP were also noted to increase BPF flow in two studies [200,204].…”

“…In studies reporting tained in 10 (83%) patients [225]. In the largest series of 29 patients treated endoscopically with fibrin blood gases, improved oxygenation was seen during HFJV and HFOV compared with conventional sealant, 16 (55%) patients had successful closure of the fistula, although 7 required permanent drainage ventilation [201][202][203]205]. Increasing levels of PEEP were also noted to increase BPF flow in two studies due to chronic empyema [226].…”

High-Frequency Ventilation

“…That HFV can maintain adequate alveolar ventilation in the face of a large air leak is undoubted, but it may do so only by its ability to generate such an enormous minute volume that the air leak becomes of little importance. 87 Albelda has recently shown in man that unless peak airway pressure was reduced with HFV no reduction occurred in the gas loss through a bronchopleural fistula, 88 Numerous clinical reports and personal experience would suggest that HFV is beneficial in neonates who develop pulmonary barotrauma related to CMV. 18,29,30,38,40 This is probably related to its ability to maintain alveolar ventilation at lower peak airway pressures, The results of controlled clinical studies are needed to determine whether HFV is of real benefit in this situation.…”