Transtracheal High Frequency Jet Ventilation 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.

Transtracheal high-frequency jet ventilation in a patient with limited mouth opening for endolaryngeal surgery: A case report

Transtracheal high-frequency jet ventilation in a patient with limited mouth opening for endolaryngeal surgery: A case report

Atemwegsmanagement – Invasives Atemwegsmanagement Update 2011

Invasive airway management techniques are still challenging even for skilled anesthesiologists, intensivists and emergency physicians. All current percutaneous tracheostomy techniques are based on Seldinger's principle. Using the recent introduced Blue Dolphin Kit is feasible and safe, but without clear advantage compared to other kits. There is no data available to generally support performing early (<8 days) tracheostomy in intensive care patients requiring mechanical ventilation. Experimental data show promising results of supporting expiration through a small bore catheter using ejectors based on Bernoulli's principle in terms of minimizing risk of barotrauma during emergency transtracheal high frequency jet ventilation.

Transtracheal jet ventilation in 50 patients with severe airway compromise and stridor

BackgroundManagement of the airway is difficult in patients with pharyngeal or laryngeal pathology caused by malignancy, extensive surgery, or radiotherapy scarring, particularly when undergoing pharyngolaryngeal surgery. Tracheal intubation, with or without fibreoptic guidance, is often impractical because of the severe glottic stenosis and primary tracheostomy under local anaesthesia has been the preferred technique. However, complication rates as high as 30% have been reported after primary tracheostomy and there is the potential for long-term morbidity. High-frequency jet ventilation (HFJV) has several advantages over other techniques in the management of the difficult airway and can be delivered by supraglottic and infraglottic routes. To date, no large series has described the use of transtracheal HFJV (TTHFJV) in adult patients with stridor and critical airway obstruction. MethodsWe report a prospective, descriptive audit of the safe use of TTHFJV in patients with severe airway compromise and stridor undergoing pharyngolaryngeal surgery (50 consecutive procedures in 44 patients). ResultsTTHFJV was successful in all 50 cases. There were no major complications and the incidence of minor complications was 20% with no subsequent morbidity. ConclusionsWe attribute this low incidence to the use of an automated jet ventilator with airway pressure monitoring and control, and the alteration of ventilator parameters by an experienced anaesthetist.

Transtracheal High-frequency Jet Ventilation using a Two-lumen Central Venous Catheter for Laryngomicrosurgery - A case report -

A 33 year old female patient was scheduled for laser laryngomicrosurgery to remove a polyp arising from the posterior one third of the vocal cord.A double lumen central venous catheter was inserted through the cricothyroid membrane and transtracheal high frequency jet ventilation was performed via the distal lumen.The proximal lumen was connected to a capnography monitor, enabling breath by breath monitoring of PETCO2.The surgery was successfully completed, and the patient was discharged from the post anesthesia care unit (PACU) three hours after surgery without any complication.

Transtracheal high-frequency jet ventilation using a two-lumen central venous catheter for laryngomicrosurgery

Received:September 6, 2007 Corresponding to:Ki-Young Lee, Department of Anesthesiology and Pain Medicine and Anesthesia, and Pain Research Institute, Yonsei University College of Medicine, 260, Seongsan-ro, Sinchondong, Seodaemun-gu, Seoul 120-752, Korea. Tel: 82-2-22282421, Fax: 82-2-312-7185, E-mail: kylee504@yumc.yonsei.ac.kr A 33 year old female patient was scheduled for laser laryngomicrosurgery to remove a polyp arising from the posterior one third of the vocal cord. A double lumen central venous catheter was inserted through the cricothyroid membrane and transtracheal high frequency jet ventilation was performed via the distal lumen. The proximal lumen was connected to a capnography monitor, enabling breath by breath monitoring of PETCO2. The surgery was successfully completed, and the patient was discharged from the post anesthesia care unit (PACU) three hours after surgery without any complication. (Korean J Anesthesiol 2008; 54: S 40~2)

Cricothyroidotomy and transtracheal high frequency jet ventilation for elective laryngeal surgery. An audit of 90 cases.

We carried out an audit of needle cricothyroidotomy and transtracheal ventilation used during anaesthesia for elective endolaryngeal surgery. The data on 90 consecutive procedures was collected over two years. Patients were anaesthetized using a total intravenous technique. An intravenous cannula or Tuohy needle was placed through the cricothyroid membrane and the patient was ventilated via the cannula using high frequency jet ventilation. Technical details of the procedure and any perioperative complications were recorded. There were 12 complications in total. Only three of these were clearly related to the cricothyroid puncture, i.e., one minor bleed and two cases of limited local surgical emphysema. All complications were minor and resolved without sequelae.

Transtracheal high frequency jet ventilation in adults and chldren

Percutaneous high frequency transtracheal jet ventilation (TTJV) is a useful technique for diagnostic and therapeutic endoscopy of the larynx and subglottic space in otolaryngological patients. It provides excellent operative conditions by increasing the exposure of the surgical field, provides adequate gas exchange and reduces ignition hazards, all conditions that greatly increase the safety of the procedure. Postoperative endotracheal intubation or even tracheotomy may thus be avoided. The insertion of the catheter is a safe procedure provided that it is performed under direct endoscopic control. Adequate monitoring of the end-expiratory pressure together with constant clinical surveillance of chest movements and gas egress are of great importance to avoid pulmonary barotrauma. Because TTJV is more invasive than orotracheal intubation, it should not be used as a routine technique in pediatric endoscopic surgery, despite its advantages. However, in selected cases such as those with upper airway stenosis, TTJV can avoid a difficult and complicated procedure or the need for a tracheotomy and should therefore be considered and performed by experienced practitioners in specialized centers.

Percutaneous transtracheal jet ventilation for paediatric endoscopic laser treatment of laryngeal and subglottic lesions

Percutaneous transtracheal high frequency jet ventilation (TTJV) in adults is frequently used during anaesthesia for laryngeal microsurgery. It provides excellent surgical operating conditions and safety for the patient. The technique has not been evaluated in infants and children. Accordingly, we studied 16 infants and children (mean age 5.5 +/- 3.8 yr, range 6 wk-12 yr) who underwent 28 consecutive endoscopic procedures with laser microsurgery of the glottic or subglottic space under general anaesthesia using a TTJV technique. All patients had a severe obstructive lesion of the larynx and/or upper trachea. The mean duration of the procedure was 70 +/- 27 min (range 30-140 min). Indications for TTJV were: subglottic stenosis: 5, haemangioma: 4, laryngeal papillomatosis: 5, pharyngeal cyst: 1, laryngomalacia: 1. Adequate control of the airway and satisfactory gas exchange were obtained in all cases. Surgery was performed without being impeded by anaesthetic equipment. Three complications occurred: one extensive surgical emphysema; one bilateral pneumothorax; one severe vagus-induced cardiovascular depression. Prompt and complete recovery without sequelae followed appropriate treatment. In 32% of the cases, the children were outpatients and in about half of the procedures (13/28) they left the hospital between the first and the third day. We conclude that percutaneous transtracheal jet ventilation is effective in paediatric endoscopic surgery. Procedures that might otherwise require a tracheostomy can be performed safely with this minimally invasive technique. Adequate indications and appropriate understanding of the technique and its potential problems are required for its correct application and successful use.

Hemodynamic and respiratory effects of transtracheal highfrequency jet ventilation during difficult intubation

Study Objective: To evaluate the hemodynamic and respiratory effects of percutaneous transtracheal high frequency jet ventilation (HFJV) during difficult intubation using fiberoptic bronchoscopy under general anesthesia. Design: Prospective study. Setting: Surgical patients scheduled for general anesthesia at the Medical College of Virginia Hospital. Patients: Eight patients with known difficult airways. Three patients had deformed facial structures. One patient had temporomandibularjoint impairment. Four patients had tumors of the oral cavity with deformed upper airways. Interventions: A 13-gauge cricothyroidotomy jet ventilation cannula was inserted percutaneously under local anesthesia. Anesthesia was induced with etomidate 0.2 to 0.3 mg/kg, alfentanil 15 to 20 Ag/kg, and vecuronium 0.1 mg/kg. HFJV was started with 100% oxygen at 30 to 35 pounds per square inch of driving pressure, 100 cycles per minute, and an inspiratorylexpiratory ratio of 25%. Thoracic electrical bioimpedonce was used to measure cardiac index (CI) and ejection fraction (EF). Measurements and Main Results: Mean arterial pressure (MAP), heart rate (HR), CI, and EF were measured before induction of anesthesia; after 1 minute of HFJV, 5 minutes of HFJV, and 10 minutes of HFJV; and during positive pressure ventilation following fiberoptic intubation. Arterial blood gas samples were obtained before induction of anesthesia and after 10 minutes of HFJV. HR decreased significantly after 5 minutes of HFJV, after 10 minutes of HFJV, and after intubation ( p < 0.05). MAP decreased significantly after 10 minutes of HFJV compared with the preinduction value (mean, 97 to 71 mmHg; p < 0.01). Although EF increased significantly following intubation, from 46% to 59%, there were no significant changes in CI. Arterial oxygen tension increased from 85 to 240 mmHg ( p < 0.05). Arterial carbon dioxide tension also increased, from 39 to 42 mmHg ( p < 0.05). Conclusions: Transtracheal HFJV under general anesthesia with etomidate, alfentanil, and vecuronium provided satisfactory hemodynamic conditions and pulmonary gas exchange. Percutaneous transtracheal HFJV can be used safely to manage patients with a difficult airway under general anesthesia using fiberoptic bronchoscopy.

Bilateral pneumothoraces after transtracheal high frequency jet ventilation during emergency tracheostomy.

Bilateral pneumothoraces after transtracheal high frequency jet ventilation during emergency tracheostomy.

Percutaneous Transtracheal High-frequency Jet Ventilation as an Aid to Fiberoptic Intubation

Percutaneous Transtracheal High-frequency Jet Ventilation as an Aid to Fiberoptic Intubation

High Frequency Jet Ventilation Versus IPPV for CPR in Dogs

Investigation of High Frequency Jet Ventilation (HFJV) for cardiopulmonary resuscitation (CPR) was initiated to determine whether HFJV may be used as an alternative to conventional intermittent positive pressure ventilation (IPPV) and also to determine whether HFJV may be employed in CPR if cardiac arrest should occur during use of HFJV.The novel method of HFJV has several advantages over conventional ventilation, namely low airway pressure, no hemodynamic impairment and no need for muscle paralysis. Transtracheal HFJV offers in addition cricothyroid membrane puncture as a fast alternative to tracheal intubation in cases of difficult airway control. It is able to prevent aspiration, and allows direct intrapulmonary drug administration.