High-frequency Jet Ventilation Group Research Articles

High Frequency Jet Ventilation or Mechanical Ventilation for Panendoscopy for Cervicofacial Cancer: A Retrospective Study.

Introduction-the upper airway panendoscopy, performed under general anesthesia, is mandatory for the diagnosis of cervicofacial cancer. It is a challenging procedure because the anesthesiologist and the surgeon have to share the airway space together. There is no consensus about the ventilation strategy to adopt. Transtracheal high frequency jet ventilation (HFJV) is the traditional method in our institution. However, the COVID-19 pandemic forced us to change our practices because HFJV is a high risk for viral dissemination. Tracheal intubation and mechanical ventilation were recommended for all patients. Our retrospective study compares the two ventilation strategies for panendoscopy: high frequency jet ventilation (HFJV) and mechanical ventilation with orotracheal intubation (MVOI). Methods-we reviewed all panendoscopies performed before the pandemic in January and February 2020 (HFJV) and during the pandemic in April and May 2020 (MVOI). Minor patients, patients with a tracheotomy before or after, were excluded. We performed a multivariate analysis adjusted on unbalanced parameters between the two groups to compare the risk of desaturation. Results-we included 182 patients: 81 patients in the HFJV group and 80 in the MVOI group. After adjustments based on BMI, tumor localization, history of cervicofacial cancer surgery, and use of muscle relaxants, the patients from the HFJV group showed significantly less desaturation than the intubation group (9.9% vs. 17.5%, ORa = 0.18, p = 0.047). Conclusion-HFJV limited the incidence of desaturation during upper airway panendoscopies in comparison to oral intubation.

High frequency jet ventilation for congenital diaphragmatic hernia

BackgroundThe optimal role of high frequency jet ventilation (HFJV) in lung protective stabilization of congenital diaphragmatic hernia (CDH) remains uncertain. We aimed to describe our center's experience with HFJV as both a rescue (following failed stabilization with CMV) and primary ventilation mode in the management of CDH. MethodsLiveborn CDH patients treated from 2013 to 2021 in a single institution were reviewed.We compared 3 groups based on their primary and last ventilation mode prior to surgery: CMV (Group 1); HFJV (Group 2); and CMV/HFJV (Group 3). Outcomes included a composite primary outcome (≥1 of mortality, need for ECMO or need for supplemental O2 at discharge), total invasive ventilation days and development of pneumothorax. A descriptive analysis including univariate group comparisons was performed. Multivariate logistic regression models investigating the relationship between mode of ventilation and the primary outcome adjusted by potentially confounding covariates were constructed. Results56 patients (32 Group 1, 18 Group 2, 6 Group 3) were analyzed. Group 2 and 3 patients had more severe disease based on liver position, SNAP-II score, pulmonary hypertension severity, need for inotropic support, CDHSG defect size and need for patch repair. There were no group differences in survival, need for ECMO, or pneumothorax occurrence, although infants receiving HFJV required longer invasive ventilation and had a greater need for O2 at discharge. Multivariate logistic regression revealed no associations between mode of ventilation and outcome. ConclusionsHFJV appears effective, both for CMV rescue and as a primary ventilation strategy in high risk CDH.Level of evidence: Level IV.

The efficacy of high-frequency jet ventilation on intraoperative oxygen saturation compared to cross-field ventilation in patients undergoing carinal resection and reconstruction.

BackgroundCross-field ventilation is used as a conventional choice during carinal resection and anastomosis, but may interfere with surgical procedures. High-frequency jet ventilation (HFJV) allows for control of oxygenation in the open airways; nevertheless, there is a paucity of data to support its benefits versus cross-field ventilation. Herein, we aimed to investigate the efficacy of HFJV on intraoperative oxygen saturation compared with cross-field ventilation in patients undergoing carinal surgeries.MethodsWe conducted a retrospective analysis of 82 adults who underwent carinal resection and reconstruction (CRR) for benign or malignant diseases and received cross-field ventilation or HFJV at Shanghai Chest Hospital between January 2018 and September 2021. Patients were excluded when they had emergency surgeries or critical airway stenosis requiring extracorporeal life support, or limited resection without the need for cross-field ventilation or HFJV. Patients were classified into two groups based on the airway approach: cross-field ventilation group and HFJV group. The primary outcome was the area under the curve (AUC) of intraoperative hypoxemia defined as peripheral oxygen saturation (SpO2) below 90% lasting at least 1 minute. The secondary outcomes included cumulative time of SpO2 below 90%, AUC and cumulative time of severe intraoperative hypoxemia (defined as SpO2 below 80% lasting at least 1 minute), and AUC and cumulative time of suboptimal SpO2 (defined as SpO2 below 95% lasting at least 1 minute).ResultsThirty-two patients were included in the final analysis, with 22 patients in cross-field ventilation group and 10 patients in HFJV group. The two groups did not differ in the severity and duration of intraoperative hypoxemia (P=0.366). The median (IQR) AUC of SpO2 below 90% was 21.92 (4.28, 54.48) min in cross-field ventilation group and 28.93 (10.78, 199.89) min in HFJV group. The cumulative time of SpO2 <90% was 16.67 (4.46, 37.11) min in cross-field ventilation group and 19.32 (7.50, 121.24) min in HFJV group, without statistical difference between groups (P>0.05). Severe intraoperative hypoxemia did not occur in either group.ConclusionsThis retrospective case series demonstrates that HFJV can be adopted to maintain oxygenation in CRR, without the interruption of surgical procedure.

Feasibility, Safety, and Short-Term Outcomes of Transcatheter Patent Ductus Arteriosus Closure in Premature Infants on High-Frequency Jet Ventilation.

BackgroundProlonged exposure to a hemodynamically significant patent ductus arteriosus (PDA) is associated with major morbidity, particularly in infants born at <27 weeks’ gestation. High‐frequency jet ventilation (HFJV) is a standard of care at our center. There are no data about transcatheter PDA closure while on HFJV. The aim of this study was to assess the feasibility, safety, and outcomes of HFJV during transcatheter PDA closure.Methods and ResultsThis is a retrospective cohort study of premature infants undergoing transcatheter device closure on HFJV. The primary outcome was successful device placement. Secondary outcomes included procedure time, fluoroscopy time and dose, time off unit, device complications, need for escalation in respiratory support, and 7‐day survival. Subgroup comparative evaluation of patients managed with HFJV versus a small cohort of patients managed with conventional mechanical ventilation was performed. Thirty‐eight patients were included in the study. Median age and median weight at PDA device closure for the HFJV cohort were 32 days (interquartile range, 25.25–42.0 days) and 1115 g (interquartile range, 885–1310 g), respectively. There was successful device placement in 100% of patients. There were no device complications noted. The time off unit and the procedure time were not significantly different between the HFJV group and the conventional ventilation group. Infants managed by HFJV had shorter median fluoroscopy times (4.5 versus 6.1 minutes; P<0.05) and no increased risk of adverse respiratory outcomes.ConclusionsTranscatheter PDA closure in premature infants on HFJV is a safe and effective approach that does not compromise device placement success rate and does not lead to secondary complications.

Is HFJV a better alternative ventilation technique for percutaneous dilatational tracheostomy? A randomized trial.

High-frequency jet ventilation (HFJV) has been used for the treatment of tracheal lesions, airway surgery, and treatment of secondary lesions after tracheostomy for many years however, reports on the use of HFJV during percutaneous dilatational tracheostomy (PDT) are limited. This study compares the use of traditional method, ventilation with laryngeal mask airway (LMA), and HFJV through endotracheal tube (ETT) with respect to the duration of PDT procedure and complications. Seventy-five patients were randomized into one of the three groups with computer-generated random numbers: Group ETT (N.=25), group LMA (N.=25), and group HFJV (n=25). Demographic data, duration of PDT, complications such as ETT cuff puncture and tube transaction, accidental extubation, difficult cannula insertion, bleeding, desaturation during the procedure, arterial blood gases immediately before and after the procedure have been recorded. Mean time for successful PDT in group ETT was 5.9±1.35 minutes, in group LMA 4.96±0.78 minutes, and 3.88±0.78 minutes in group HFJV. PDT duration was shorter in the LMA group than in the ETT group (P<0.05). In the HFJV group, the PDT duration was shorter than the LMA group (P<0.05) and the ETT group (P<0.001). In terms of the total number of complications, significantly fewer complications were observed in the HFJV group compared with group ETT and group LMA. HFJV may be a more effective alternative method for airway management during PDT, facilitating and reducing the duration of the intervention.

Application of high frequency jet ventilation system in laryngopharyngeal and tracheal surgery

Objective:The effectiveness and safety of high frequency ventilation system in laryngopharyngeal and tracheal surgery is discussed. Methods:According to The American Society of Anesthesiologists Ⅰ-Ⅱ level, 60 cases of selective throat and tracheal surgery undering general anesthesia were randomly divided into high frequency jet ventilation group （group HFJV） and intermittent positive pressure ventilation group （IPPV group）, with 30 cases in each group. Group HFJV was treated with HFJV and group IPPV with a small caliber endotracheal tube connected to an anesthesia machine was treated with IPPV.Before anesthesia （T0）, after the success of the laryngoscope placed （T1）, 5 minites after ventilation （T2） and 5 minites after the laryngoscope removed （T3）, hemodynamic parameters were recorded at each time point , in T0, T2 and T3 record , arterial blood gas index, the patient's airway pressure, end-expiratory carbon dioxide concentration, surgical field quality and total blood loss, operating time and awakening time were recorded and compared between the two groups. Results:The average airway pressure and intraoperative average total blood loss of group HFJV were significantly lower than that of group IPPV（P<0.01）, and the average operative field quality of group HFJV was significantly better（P<0.01）, but there was no statistical significance in the effects on hemodynamics, arterial blood gas and other indicators compared with group IPPV（P>0.05）. No serious adverse events occurred in 2 groups. Conclusion:HFJV system can be used effectively in laryngopharyngeal and tracheal surgery, reducing intraoperative blood loss and improving surgical field of vision without obvious adverse reactions.

"Selective bronchus-blowing" method for effective inflate-deflate line identification in lung segmentectomy.

BackgroundWe examined two methods for the intraoperative selective bronchial delivery of air, and compared their effectiveness.MethodsWe recruited patients undergoing lung resection with the selective bronchus-blowing method in pulmonary segmentectomy for lung tumors. We assessed two types of bronchial ventilation methods: high-frequency jet ventilation (HFJV) and the bronchus-blowing method, which deliver air to target bronchi using HFJV or a 20G cannula inserted directly into the bronchi, respectively. The inflate-deflate line was classified as clear, slightly clear, and unclear. We examined the relationships between clinicopathological findings and the inflate-deflate line classification, as well as group differences in surgical-related factors.ResultsAmong the 86 patients enrolled, 45 received HFJV ventilation and 41 received the bronchus-blowing method of ventilation. There was a significantly higher incidence of complex-type segmentectomies among patients in the bronchus-blowing group than in the HFJV group. The inflate-deflate line was classified as clear, slightly clear, and unclear in 16/7/11 and 25/3/3 patients in the HFJV and bronchus-blowing groups, respectively, according to the inflate-deflate criteria. The inflate-deflate line was identifiable in more cases in the bronchus-blowing group than in HFJV group (P=0.02). Complete resection was significantly less frequent in the HFJV group (73.5%) than in the bronchus-blowing group (90.3%). The rate of unsuccessful surgery was significantly higher among patients with severe emphysema, interstitial pneumonia, and anthracosis.ConclusionsIntraoperative selective bronchial air supply was attempted for the safe identification of target lung segments. The bronchus-blowing method easily enabled effective visualization of the segmental area within the operative field.

Effects of penehyclidine hydrochloride combined with unilateral high-frequency jet ventilation on pulmonary function and inflammatory response during one-lung ventilation in patients with chronic obstructive pulmonary disease

Objective To evaluate the effects of penehyclidine hydrochloride (PHCD) combined with high-frequency jet ventilation (HFJV) of the operated lungs on pulmonary function and inflammatory response during one-lung ventilation (OLV) in patients with chronic obstructive pulmonary disease (COPD). Methods Sixty American Society of Anesthesiologists physical status Ⅱ or Ⅲ patients of both sexes with COPD, aged 40-64 yr, with body mass index of 17-26 kg/m2, scheduled for elective video-assisted thoracoscopic surgery under general anesthesia, were divided into 4 groups (n=15 each) using a random number table method: conventional group (group C), PHCD group (group P), HFJV group (group H) and PHCD combined with HFJV group (group PH). After induction of anesthesia, the patients were intubated with a double-lumen tube and then mechanically ventilated, with inspired oxygen concentration 100%, oxygen flow rate 2 L/min, tidal volume 6-8 ml/kg, respiratory rate 10-14 breaths/min, and respiratory rate was set at 12-16 breaths/min and PETCO2 was maintained at 40-45 mmHg during OLV.PHCD 0.01 mg/kg was intravenously injected before intubation in P and PH groups.The ventilation mode was changed to OLV after beginning of skin incision in each group.Ventilation of the lung on the operated side was performed by means of HFJV(driving pressure 0.5 kg/cm2)during OLV in P and PH groups.The pneumodynamic parameters such as airway peak pressure (Ppeak), airway plateau pressure (Pplat), airway resistance (Raw) and dynamic lung compliance (Cdyn) were monitored immediately before skin incision (T1) and at 60 and 120 min of OLV (T2, 3). Arterial blood samples were obtained at T2 for blood gas analysis, and oxygenation index (OI), respiratory index (RI), physiologic dead space fraction (VD/VT) and alveolar-arterial oxygen gradiant (A-aDO2) were calculated.Venous blood samples were drawn at T3 for determination of the serum concentrations of tumor necrosis factor-alpha (TNF-α), interleukin-6 (IL-6) and IL-8 by enzyme-linked immunosorbent assay.The occurrence of pulmonary complications was recorded within 72 h after operation. Results Compared with group C, the serum concentrations of TNF-α, IL-6 and IL-8, Ppeak, Pplat, Raw, RI, VD/VT, A-aDO2 and incidence of pulmonary complications were significantly decreased, and Cdyn and OI were increased in group P and group PH (P<0.05), and the serum concentrations of TNF-α, IL-6 and IL-8, RI, VD/VT, A-aDO2 and incidence of pulmonary complications were significantly decreased, and OI was increased in group H (P<0.05). Compared with group P or group H, the serum concentrations of TNF-α, IL-6 and IL-8, RI, VD/VT, A-aDO2 and incidence of pulmonary complications were significantly decreased, and OI was increased in group PH (P<0.05). Conclusion PHCD combined with HFJV of the operated lung produces better efficacy in improving respiratory function, inhibiting inflammatory responses, reducing lung injury and is more helpful in improving prognosis than either alone in the patients with COPD. Key words: Cholinergic antagonists; High-frequency jet ventilation; Pulmonary disease, chronic obstructive; Respiratory function tests; Systemic inflammatory response syndrome

High-Frequency Jet Ventilation During Cryoablation of Small Renal Tumours

AimTo evaluate the effect of high-frequency jet ventilation (HFJV) in place of standard intermittent positive-pressure ventilation (IPPV) on procedure duration, patient radiation dose, complication rates, and outcomes during CT-guided cryoablation of small renal tumours.Materials and MethodsOne hundred consecutive CT-guided cryoablation procedures to treat small renal tumours under general anaesthesia were evaluated—50 with standard IPPV and 50 after the introduction of HFJV as standard practice. Anaesthesia and procedural times, ionising radiation dose, complications, and 1-month post-treatment outcomes were collected.ResultsHFJV was feasible and safe in all cases. Mean procedure time and total anaesthetic time were shorter with HFJV (p = <0.0001). The number of required CT acquisitions (p = 0.0002) and total procedure patient radiation dose (p = 0.0027) were also lower in the HFJV group compared with the IPPV group. There were a total of four complications of Clavien–Dindo classification 3 or above—three in the IPPV group and one in the HFJV group. At 1-month follow-up, two cases (both in the IPPV group) demonstrated subtotal treatment. Both cases were subsequently successfully retreated with cryoablation.ConclusionBy reducing target tumour motion during CT-guided renal cryoablation, HFJV can reduce procedure times and exposure to ionising radiation. HFJV provides an important adjunct to complex image-guided interventions, with potential to improve safety and treatment outcomes.

High Frequency Jet Ventilation during Transoral Laser Microsurgery for Tis-T2 Laryngeal Cancer.

Transoral laser microsurgery (TLM) for early to intermediate laryngeal squamous cell cancer (SCC) can be technically challenging when adequate exposure of the posterior laryngeal compartment is required due to the presence of the orotracheal tube. The goal of our study was to analyze the efficacy of high frequency jet ventilation (HFJV) in achieving appropriate laryngeal exposure and safe oncologic resection of lesions located in such a position. We reviewed the clinical records of 62 patients affected by Tis-T2 SCC of the posterior laryngeal compartment treated by TLM between 02/2012 and 12/2016. The cohort was divided into two groups according to the anesthesiologic technique used: Group A included patients treated using intraoperative infraglottic HFJV, while Group B encompassed patients treated by standard orotracheal intubation. The main outcome was postoperative surgical margin status. Group comparison analysis was performed. Significant difference in deep margin status was observed between the two groups: in Group A, the rate of negative deep margins was 86% compared to 56% in Group B (p = 0.04). A trend of better overall and superficial margin control was observed for patients treated using HFJV (Group A), although no statistical significance was achieved. Use of HFJV during TLM allows easier and safer management of patients affected by Tis-T2 SCC of the posterior laryngeal compartment, reducing the rates of positive superficial and deep surgical margins.

High-frequency jet ventilation shortened the duration of gas embolization during laparoscopic liver resection in a porcine model

Positive pressure mechanical ventilation causes rhythmic changes in thoracic pressure and central blood flow. If entrainment occurs, it could be easier for carbon dioxide to enter through a wounded vein during laparoscopic liver lobe resection (LLR). High-frequency jet ventilation (HFJV) is a ventilating method that does not cause pronounced pressure or blood flow changes. This study aimed to investigate whether HFJV could influence the frequency, severity, or duration of gas embolism (GE) during LLR. Twenty-four anaesthetized piglets underwent lobe resection and were randomly assigned to either normal frequency ventilation (NFV) or HFJV (n=12 per group). During resection, a standardized injury to the left hepatic vein was created to increase the risk of GE. Haemodynamic and respiratory variables were monitored. Online blood gas monitoring and transoesophageal echocardiography were used. GE occurrence and severity were graded as 0 (none), 1 (minor), or 2 (major), depending on the echocardiography results. GE duration was shorter in the HFJV group (P=0.008). However, no differences were found between the two groups in the frequency or severity of embolism. Incidence of Grade 2 embolism was less than that found in previous studies and physiological responses to embolism were variable. HFJV shortened the mean duration of GE during LLR and was a feasible ventilation method during the procedure. Individual physiological responses to GE were unpredictable.

Effects of peritoneal jet ventilation on peritoneal oxygenation in pigs

Objective To evaluate the effects of peritoneal jet ventilation on peritoneal oxygenation in pigs.Methods Twenty-four pigs of both sexes (12-16 weeks,35-45 kg) were randomly divided into 3 groups (n=8 each): sham operation group (group S) ; peritoneal regular frequency jet ventilation group (16 bpm)(group N) and peritoneal high-frequency jet ventilation group (150 bpm) (group H).Oral tracheal intubation was performed.The animals were mechanically ventilated (VT 8-12 ml/kg,RR 12-16 bpm,I:E 1.0:1.5,FiO2 100％) via airway.Endotracheal tubes were inserted into abdomen through the incisions in the left lower (for peritoneal jet ventilation) and right upper quadrant (for outlet of air).Arterial blood PaO2 and PaCO2 were measured before (baseline) and at 30,60,90,120,150,180,210 and 240 s of peritoneal jet ventilation.Peritoneal jet ventilation was started after the lungs being mechanically ventilated for 35 min.Peritoneal jet ventilation was terminated when SpO2 dropped to SpO2 ＜ 90 ％.The duration of safe apnea (DSA,from the moment of begging of peritoneal jet ventilation to the time when PaO2 ＜ 60 mm Hg).Results PaO2 was significandy higher and DSA longer in group H than in groups S and N.But there was no significant difference in PaCO2 among the 3 groups.Conclusion Peritoneal high-frequency jet ventilation can significantly enhance the efficiency of peritoneal oxygenation and prolong DSA,while peritoneal regular frequency jet ventilation has no effect on peritoneal oxygenation. Key words: Respiration,artificial; Abdominal cavity; Peritoneum; Extracorporeal membrane oxygenation

The effect of positive-end expiratory pressure on oxygenation during high frequency jet ventilation and conventional mechanical ventilation in the rabbit model of acute lung injury.

BackgroundThe use of positive end expiratory pressure (PEEP) in patients with acute lung injury (ALI) improves arterial oxygenation by alleviating pulmonary shunting, helping the respiratory muscles to decrease the work of breathing, decreasing the rate of infiltrated and atelectatic tissues, and increasing functional residual capacity. In a rabbit model of saline lavage-induced ALI, we examined the effects of PEEP on gas exchange, hemodynamics, and oxygenation during high frequency jet ventilation (HFJV), and then compared these parameters with those during conventional mechanical ventilation (CMV).MethodsTwelve rabbits underwent repeated saline lavage to create ALI. The animals were divided in 2 groups: 1) Group CMV (n = 6), and 2) Group HFJV (n = 6). In both groups, we applied 2 levels of PEEP (5 cmH2O and 10 cmH2O) and then measured the arterial blood gas, mixed venous blood gas, and hemodynamic parameters.ResultsWith administration of PEEP of either 5 cmH2O or 10 cmH2O, the arterial oxygen content of both groups was increased, although without statistically significant differences between groups. On the contrary, the arterial carbon dioxide content was significantly decreased in the HFJV group, as compared with the CMV group, during the entire experiment. Furthermore, there was significant decreases in mean arterial pressures in both groups with a PEEP of 10 cmH2O.ConclusionsThe application of PEEP in rabbits with ALI effectively improves oxygenation in either HFJV or CMV.

CT-guided Navigation of Percutaneous Hepatic and Renal Radiofrequency Ablation under High-frequency Jet Ventilation: Feasibility Study

Purpose Computed tomography (CT)–guided navigation during percutaneous radiofrequency (RF) ablations of liver and kidney lesions is hampered by respiratory motion and time-dependent lesion conspicuity after contrast agent injection. Therefore, target immobilization by general anesthesia with high-frequency jet ventilation (HFJV) instead of conventional ventilation (CV) with repeated breath-holds may facilitate and speed up navigation of RF ablation probes. Materials and Methods Nineteen consecutive patients who underwent percutaneous RF ablation of liver (n = 9) or renal tumors (n = 10) with CT guidance under HFJV (n = 9) or CV (n = 10) were included. The choice of the anesthesiologic technique was left to the discretion of the interventionalist. Complexity of the intervention (ie, number of lesions ablated per session, conspicuity of the lesion on nonenhanced CT, and access pathway), volume of the ablated tissue, radiation exposure, and complications were compared between the HFJV and CV groups. Results In this feasibility study, a statistically significant radiation dose reduction ( P < .05) was noted in the HFJV group compared with the CV group for liver and renal RF ablation. No complications were observed in the HFJV group, whereas renal subcapsular hematoma (n = 2) and pulmonary embolism (n = 1) occurred in the CV group. Conclusions Percutaneous CT-guided navigation of RF ablation probes under HFJV is feasible and safe. It might be advantageous for the treatment of complex kidney and liver tumors, allowing less irradiation exposure to the patient and the interventional radiologist.

High-frequency jet ventilation is beneficial during shock wave lithotripsy utilizing a newer unit with a narrower focal zone

High-frequency jet ventilation (HFJV) during shock wave lithotripsy (SWL) has been reported using older lithotripsy units with larger focal zones. We investigated how HFJV affects the clinical parameters of SWL using a newer lithotripsy unit with a smaller focal zone. We reviewed all patients who underwent SWL by a single surgeon (KVA) from July 2006 until December 2007 with the Siemens Lithostar Modularis (Siemens AG, Erlangen, Germany). Either HFJV or conventional anesthetic techniques were used based on the anesthesiologists' preference. Preoperative imaging was reviewed for stone size, number and location. Total operating room time, procedure time, number of shocks and total energy delivery were analyzed. Postoperative imaging was reviewed for stone-free rates. A total of 112 patients underwent SWL with 80 undergoing conventional anesthesia, and 32 with HFJV. Age, body mass index, preoperative stone size and number were not significantly different between the groups. The HFJV group required significantly less total shocks (3358 vs. 3754, p = 0.0015) and total energy (115.8 joules vs. 137.2 joules, p = 0.0015). Total operating room time, SWL procedure time and postoperative stone-free rates were not significantly different. Previous studies using older SWL units with larger focal zones have demonstrated that HFJV can be effective in reducing total shocks and total energy. Our data is consistent with these studies, but also shows benefit with newer units that have narrower focal zones.

High-Frequency Jet Ventilation as an Alternative Method Compared to Conventional One-Lung Ventilation Using Double-Lumen Tubes During Minimally Invasive Coronary Artery Bypass Graft Surgery

To optimize the conditions for the surgeon during minimally invasive direct coronary artery bypass (MIDCAB) and totally endoscopic coronary artery bypass (TECAB) procedures, one-lung ventilation (OLV) is required using double-lumen tubes (DLT). This prospective study was designed to compare high-frequency jet ventilation (HFJV) of both lungs with the conventional method of OLV via DLT. Prospective, randomized, clinical study. University-affiliated heart center. Forty patients with coronary artery disease and scheduled for elective MIDCAB or TECAB procedures were equally randomized into a DLT and an HFJV group. In the DLT group, OLV of the right lung was performed throughout the surgical procedure. In the HFJV group, patients received a conventional single-lumen endotracheal tube and both lungs were ventilated using HFJV. Hemodynamic, oxygenation and ventilation parameters were measured at the beginning of the operation, then 5, 15, 30, and 60 minutes after OLV/HFJV, as well as immediately before transfer to the ICU. Regarding the view of the surgical field, surgeons' comfort did not differ between methods. The intraoperative PaO(2) was significantly higher in the HFJV group compared with the DLT group at 5 (336.8 +/- 123.3 v 228.6 +/- 124.0; p = 0.009) and 15 minutes (301.7 +/- 133.9 v 192.6 +/- 92.8; p = 0.012). The PaCO(2) was significantly higher in the HFJV group after 5 minutes and persisted through 60 minutes of ventilation. The peak inspiratory pressure was significantly lower during HFJV (10.0 +/- 2.8 mbar v 32.1 +/- 5.9 mbar). HFJV in MIDCAB or TECAB procedures appears to be a feasible alternative to OLV using a DLT, although study in a larger population is required.

The quality of the surgical field during functional endoscopic sinus surgery—The effect of the mode of ventilation—A randomized, prospective, double-blind study

The outcome of functional endoscopic sinus surgery (FESS) depends on a clean surgical field achieved by minimizing intraoperative bleeding. High frequency jet ventilation (HFJV), due to lower airway pressures, offers the benefit of improved venous return, less bleeding, and improved operating conditions. HFJV was compared to intermittent positive pressure ventilation (IPPV) by assessment of surgical conditions and measurement of intraoperative blood loss. Prospective, randomized, double-blind study. A total of 22 patients undergoing FESS were randomly assigned to be ventilated during surgery under general anesthesia by either HFJV or IPPV. The quality of the surgical field was assessed and the total blood loss was measured. The mean airway pressure was significantly lower in the HFJV group than in the IPPV group (2.42 +/- 1.17 and 7.11 +/- 0.72, respectively, P < .0001). The total mean loss of blood in the HFJV group was 170 cc and in the IPPV group was 318.18 cc (P = .017). The quality of the surgical field as estimated by the surgeon was significantly better in the HFJV group. The mean point values on the Boezaart et al. scale for the IPPV and HFJV groups were 2.72 +/- 0.77 and 1.80 +/- 0.686, respectively (P = .012). HFJV significantly reduced the amount of intraoperative bleeding and thus significantly improved the quality of the surgical field. It is suggested that increased venous return due to lower intrathoracic pressures resulted in less bleeding and improved operating conditions. HFJV can be effectively used for FESS in order to improve endoscopic view with no adverse effects.

Comparison of Two Ventilation Techniques During General Anesthesia for Extracorporeal Shock Wave Lithotripsy: High-Frequency Jet Ventilation Versus Spontaneous Ventilation with a Laryngeal Mask Airway

To compare high-frequency jet ventilation (HFJV) with spontaneous ventilation (SV) in general anesthesia for extracorporeal shock wave lithotripsy (ESWL). We conducted a retrospective review of 91 consecutive patients undergoing either HFJV with a Ben Jet airway or SV with a laryngeal mask airway, comparing the total number of shocks for stone ablation and the time in the post-anesthetic care unit between groups. Stone ablation rates on postoperative x-rays were compared. The HFJV group needed significantly fewer shocks for stone ablation (median, 2000 versus 3000, P = 0.0001), and there was no difference in post-anesthetic care unit time. No patient in either group had significant clinical signs of ESWL-related tissue trauma. There was no difference in stone ablation rates on follow-up x-ray (HFJV 77% versus SV 74%). This study supports the use of HFJV as a ventilation mode for ESWL when general anesthesia is chosen. Similar stone fragmentation rates can be achieved with fewer shocks, which may have beneficial effects, such as less pain and nausea, requiring further study.

Comparison of double-lung jet ventilation and one-lung ventilation for thoracotomy

Thoracic surgery requires immobilization of the operating area. Usually, this is achieved with one-lung ventilation (OLV), however this may still lead to some movement. High-frequency jet ventilation (HFJV) may be an alternative way of ventilation in thoracic surgery. The purpose of this study was to determine the effectiveness of HFJV as an alternative option to OLV for thoracic procedures. Sixty patients were randomized to receive either HFJV (n = 29) or OLV (n = 31) during the operation. During the course of the study 10 patients were excluded (4 patients in HFJV group and 6 patients in OLV group). The following haemodynamic and ventilatory parameters were recorded: heart rate, systolic and mean blood pressure, ventricular stroke volume, cardiac index, systemic vascular resistance, peak inspiratory pressure, oxygen saturation, PaO2 and PaCO2. Overall parameters were documented before the initiation of the chosen mode of ventilation every 15 min during the operation. Patients in both groups showed comparable cardiovascular function. Mean values of peak inspiratory pressure were significantly higher in the OLV group. Oxygen saturation values were statistically higher in the HFJV group. PaCO2 values were similar in both during surgery, but were higher in the OLV group after awakening. Mean values of shunt fraction were lower in the HFJV group. Lower values of peak inspiratory pressure were therefore associated with higher partial pressure of carbon dioxide levels in the HFJV group. In the OLV group, 44% of patients experienced a postoperative sore throat. Operating conditions were comparable. HFJV is safe option, comparable to OLV and offers some advantages for open-chest thoracic procedures.

Effect of high-frequency jet ventilation on oxygenation during one-lung ventilation in patients undergoing thoracic aneurysm surgery

To evaluate the effect of high-frequency jet ventilation (HFJV) and continuous positive airway pressure (CPAP) on oxygenation and the shunt fraction (Qs/Qt) during one-lung ventilation (OLV). Twenty-five patients who were undergoing resection of a descending aortic aneurysm were studied. Arterial oxygenation, Qs/Qt, and hemodynamics were evaluated just before the initiation of OLV (T1), 15 min after OLV (T2), and 15 min (T3) and 30 min (T4) after the application of HFJV or CPAP to the nondependent lung. There were no significant changes in the mean arterial blood pressure (MAP), heart rate (HR), central venous pressure (CVP), or mixed venous partial pressure of oxygen throughout this study. The arterial partial pressure of oxygen (Pa(O2)) values after the application of HFJV or CPAP increased significantly, from 173.8 +/- 39.6 mmHg (T2) to 344.1 +/- 87.9 mmHg (T3) and 359.9 +/- 82.4 mmHg (T4) in the HFJV group (P < 0.05), and from 153 +/- 38.5 mmHg (T2) to 243 +/- 48.5 mmHg (T3) and 249.7 +/- 55.0 mmHg (T4) in the CPAP group (P < 0.05). The shunt fraction decreased significantly after the initiation of HFJV or CPAP, from 38.7% +/- 8.9% (T2) to 27.0% +/- 8.0% (T3) and 25.9% +/- 8.7% (T4) in the HFJV group (P < 0.05), and from 44.6% +/- 8.6% (T2) to 34.3% +/- 10.2% (T3) and 32.6% +/- 8.5% (T4) in the CPAP group (P < 0.05). The arterial saturation of oxygen (Sa(O) (2)) increased significantly after the application of either HFJV or CPAP (P < 0.05). Both HFJV and CPAP can improve oxygenation during OLV.