Use Of High-frequency Jet Ventilation Research Articles

Recovery and safety with prolonged high-frequency jet ventilation for catheter ablation of atrial fibrillation: A hospital registry study from a New England healthcare network

Study objectiveTo investigate post-procedural recovery as well as peri-procedural respiratory and hemodynamic safety parameters with prolonged use of high-frequency jet ventilation (HFJV) versus conventional ventilation in patients undergoing catheter ablation for atrial fibrillation. DesignHospital registry study. SettingTertiary academic teaching hospital in New England. Patients1822 patients aged 18 years and older undergoing catheter ablation between January 2013 and June 2020. InterventionsHFJV versus conventional mechanical ventilation. MeasurementsThe primary outcome was post-anesthesia care unit (PACU) length of stay. In secondary analyses we assessed the effect of HFJV on intra-procedural hypoxemia, defined as the occurrence of peripheral hemoglobin oxygen saturation (SpO2) <90%, post-procedural respiratory complications (PRC) as well as intra-procedural hypocarbia and hypotension. Multivariable negative binomial and logistic regression analyses, adjusted for patient and procedural characteristics, were applied. Main results1157 patients (63%) received HFJV for a median (interquartile range [IQR]) duration of 307 (253–360) minutes. The median (IQR) length of stay in the PACU was 244 (172–370) minutes in patients who underwent ablation with conventional mechanical ventilation and 226 (163–361) minutes in patients receiving HFJV. In adjusted analyses, patients undergoing HFJV had a longer PACU length of stay (adjusted absolute difference: 37.7 min; 95% confidence interval [CI] 9.7–65.8; p = 0.008). There was a higher risk of intra-procedural hypocarbia (adjusted odds ratio [ORadj] 5.90; 95%CI 2.63–13.23; p < 0.001) and hypotension (ORadj 1.88; 95%CI 1.31–2.72; p = 0.001) in patients undergoing HFJV. No association was found between the use of HFJV and intra-procedural hypoxemia or PRC (p = 0.51, and p = 0.97, respectively). ConclusionAfter confounder adjustment, HFJV for catheter ablation procedures for treatment of atrial fibrillation was associated with a longer length of stay in the PACU. It was further associated with an increased risk of intra-procedural abnormalities including abnormal carbon dioxide homeostasis, as well as intra-procedural arterial hypotension.

In-Circuit High-Frequency Jet Ventilation for Radiological Tumor Ablation: A Case Series.

High-frequency jet ventilation (HFJV) can reduce organ movement that otherwise complicates percutaneous image-guided ablation (IGA) procedures. This study describes feasibility and safety of the technique in routine use. We describe our method for the use of HFJV and present 169 consecutive cases, including IGA of tumors of the lung, liver, kidney, and pancreas. Intended oncological treatment was delivered in all cases and HFJV used for the duration of treatment in all except one case. We describe the characteristics of patients, procedures, and adverse events. It is feasible to use HFJV as the routine standard of care for IGA.

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.

First intention high-frequency jet ventilation for periviable infants.

Ventilation of periviable infants born at 22-23 weeks gestation remains a challenge in neonatology. This review highlights the evidence surrounding the use of first intention high-frequency jet ventilation (HFJV) in infants born near the limits of viability with a review of pulmonary fetal development and a focused overview of HFJV strategies including an in-depth analysis of the management strategies used in the initial randomized trials. A paucity of recent trials exists, with no randomized control trials assessing the use of first intention HFJV performed in the last 25 years. A retrospective observational cohort trial of the use of HFJV for infants born at less than 750 g has been recently published demonstrating the efficacy of HFJV for this population even with 2.0-mm endotracheal tubes. The lack of recent randomized trials contributes to the controversy surrounding the use of first intention HFJV. Although new research is needed in the area, this review includes the ventilation strategy of an experienced center with a focus on the use of first intention HFJV for the care of premature infants born less than 24 weeks gestation.

Use of High-Frequency Jet Ventilation During Percutaneous Tracheostomy

Use of High-Frequency Jet Ventilation During Percutaneous Tracheostomy

Anesthesiological management of the precise transuretral contact nephrolithotripsy using high-frequency jet ventilation

The anesthesia management during contact transurethral nefrolithotripsy (CLT) requires minimizing kidney movements, caused by standard mechanical ventilation ( М V) during general anesthesia (G А ). Modifying the respiratory support, in particular by adding high-frequency jet ventilation (HFJV), allows decreasing kidney movements during CLT. The objective : to evaluate the possibilities of anesthetic management and surgical conditions during the MV modified with HFJV during kidney stones laser fragmentation under GA. Subjects and methods . The study included 30 patients underwent CLT under GA maintained with sevoflurane. At the stage of lithotripsy, the standard MV was modified and combined with catheter HFJV. ASA basic anesthetic monitoring and the control of patient consciousness level with BIS were performed. Surgical conditions during CLT were evaluated before and after HFJV. Results and discussion . The combination of HFJV with small volume MV makes it possible to provide sufficient sevoflurane end tidal concentration to maintain GA. The indices of ventilation, gas exchange and hemodynamics values remained within the safe ranges. Using HFJV and small volume MV reduces kidney respiratory movements. Surgical assessment during MV with HFJV was significantly better versus standard MV. Conclusions . The use of HFJV with small volume MV during GA with sevoflurane decreases the kidney respiratory movement and allows precise CLT, effective MV and well-controlled anesthesia depth.

Initiation of a High-Frequency JetVentilation Strategy for CatheterAblation for Atrial Fibrillation: Safety and Outcomes Data.

The aim of the current investigation is to examine whether use of high-frequency jet ventilation (HFJV) during pulmonary vein isolation (PVI) performed with force-sensing catheters is associated with improved outcomes. Catheter ablation is well established as therapy for symptomatic atrial fibrillation (AF). Reconnection following PVI is commonly observed during repeat ablation procedures. Technologies that may optimize catheter stability and lesion delivery include both force-sensing ablation catheters and HFJV. Patients undergoing PVI at Johns Hopkins Hospital were prospectively enrolled in a registry. The study compared procedural characteristics, adverse event rates, and 1-year procedural outcomes in patients undergoing PVI supported either by standard ventilation or HFJV. Patient and procedural aspects were otherwise constant. Eighty-four HFJV patients and 84 matched control patients with 1-year outcome data were identified. Atrial arrhythmia recurrence occurred in 26 of 84 HFJV patients (31%) and 42 of 84 control patients (50%; p= 0.019). In patients with paroxysmal AF, arrhythmia recurrence in HFJV and control patients was 27.3% and 47.3%, respectively (p=0.045). In patients with persistent AF, arrhythmia recurrence rates were not significantly different (37.9% in HFJV patients, 55.2% in control patients; p= 0.184). On multivariate analysis, HFJV was independently associated with improved freedom from arrhythmia recurrence. Vasopressor use during HFJV cases was significantly higher than during standard ventilation (79.7% vs. 22.4%; p= 0.001). Indices of catheter stability and contact force adequacy were significantly higher in the HFJV patients than in control patients. Complication rates in the 2 groups were similarly low. Use of HFJV in patients undergoing PVI with radiofrequency force-sensing catheters is associated with improved outcomes, without appreciable increase in adverse procedural events.

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 for motion management during ablation procedures, a narrative review.

High frequency jet ventilation (HFJV) is a method of ventilation that has gained renewed interest over the recent years as it can reduce organ movement to near static conditions, thus enhancing surgical precision in minimal invasive procedures, for example, ablation procedures for atrial fibrillation and solid organ tumours. The aim of this review was to create a summary of the current evidence concerning the clinical use of HFJV for ablative procedures. PubMed was searched for the key words high frequency ventilation and ablation January 1990-December 2016. The search initially identified 34 papers, 14 met the inclusion criteria. Articles in other languages than English (n = 1), comments regarding other articles (n = 4) and articles that did not include HFJV or ablative procedures (n = 15) were excluded. Two articles were added from references in papers included from the primary search. Sixteen studies were finally included in the review; four updates/reviews and 12 papers with results from studies of HFJV on humans, with a total of 889 patients; 498 patients ventilated with HFJV and 391 controls. There were no randomised studies. The overall scientific quality of the studies was low. There is a lack of well-designed studies evaluating HFJV during ablation procedures. The available information, while sparse, supports the effect of less tissue movement, resulting in better surgical precision and outcome; such as shorter procedural time, fewer shock waves (ESWL) and less recurrence of atrial fibrillation. Randomised controlled studies are needed in this promising area of research to prove its superiority to standard ventilation.

High Frequency Jet Ventilation in Respiratory Failure Secondary to Respiratory Syncytial Virus Infection: A Case Series.

To describe the utility of high frequency jet ventilation (HFJV) as a rescue therapy in patients with respiratory failure secondary to respiratory syncytial virus (RSV) that was refractory to conventional mechanical ventilation (CMV). Descriptive study by retrospective review. Pediatric intensive care unit at a tertiary care children's hospital. Infants on mechanical ventilation for respiratory failure due to RSV. Use of HFJV. Eleven patients were placed on HFJV. There was sustained improvement in ventilation on HFJV with a mean decrease in PCO2 of 9 mmHg at 24 h and 11 mmHg at 72 h. There were no significant changes in oxygenation by oxygenation index. No patients required extracorporeal support or suffered pneumothorax, pneumomediastinum, or subcutaneous emphysema. Ten out of 11 (91%) patients survived to discharge from the hospital. High frequency jet ventilation may represent an alternative therapy for RSV-induced respiratory failure that is refractory to CMV.

Technical description of a modified jet ventilation injector for airway laser surgery in neonates and infants: retrospective analysis of 20 cases

IntroductionThe authors modified an adult jet ventilation injector (Hunsaker Mon-Jet Ventilation Tube®) to be able to provide transglottal high-frequency jet ventilation (HFJV) in small children undergoing laryngeal procedures with CO2 laser. Methods and materialRetrospective review of the anesthetic records of all children younger than 2years undergoing transglottal HFJV for CO2 laser laryngeal procedures using this modified adult injector between 2006 and 2013. ResultsNine children (5 boys, 4 girls) were identified who underwent a total of 20 procedures. Mean age was 7.4 ± 6.9months, and mean weight was 6 ± 2.8 kg. No complications were observed with the use of HFJV or this modified injector. ConclusionIn experienced hands, this modified injector ensures excellent visibility and field access to the surgeon as well as adequate ventilation during laryngeal laser surgery in infants.

Use of High-Frequency Jet Ventilation for Percutaneous Tumor Ablation

To report feasibility and potential benefits of high-frequency jet ventilation (HFJV) in tumor ablations techniques in liver, kidney, and lung lesions. This prospective study included 51 patients (14 women, mean age 66 years) bearing 66 tumors (56 hepatic, 5 pulmonary, 5 renal tumors) with a median size of 16 ± 8.7 mm, referred for tumor ablation in an intention-to-treat fashion before preoperative anesthesiology visit. Cancellation and complications of HFJV were prospectively recorded. Anesthesia and procedure duration, as well as mean CO2 capnea, were recorded. When computed tomography guidance was used, 3D spacial coordinates of an anatomical target <2 mm in diameter on 8 slabs of 4 slices of 3.75-mm slice thickness were registered. HFJV was used in 41 of 51 patients. Of the ten patients who were not candidate for HFJV, two patients had contraindication to HFJV (severe COPD), three had lesions invisible under HFJV requiring deep inspiration apnea for tumor targeting, and five patients could not have HFJV because of unavailability of a trained anesthetic team. No specific complication or hypercapnia related to HFJV were observed despite a mean anesthetic duration of 2 h and ventilation performed in procubitus (n = 4) or lateral decubitus (n = 6). Measured internal target movement was 0.3 mm in x- and y-axis and below the slice thickness of 3.75 mm in the z-axis in 11 patients. HFJV is feasible in 80 % of patients allowing for near immobility of internal organs during liver, kidney, and lung tumor ablation.

Anästhesiologische Besonderheiten bei der laryngotrachealen Chirurgie

During surgical procedures of the upper respiratory tract anesthesiologists and surgeons are in a kind of competition situation because of the close spatial relationship between the airway of the patient and the surgical area. Especially in laryngeal surgery the use of high-frequency jet ventilation (HFJV) offers an alternative to the endotracheal tube. During HFJV the ventilation gas is intermittently administered by an injector with a high frequency into the airway which is open to the outside. Exhalation occurs passively in the area nearby the wall of the airway cross-section. According to the availability of the technique and the indications jet ventilation can be implemented in an infraglottic, supraglottic, transtracheal or transluminal manner. To exert influence on gas exchange of the patient the respiratory rate, driving pressure, oxygen concentration and inspiration time can be changed according to the needs. Severe tracheal stenosis, risk of excessive bleeding during the procedure, patients at risk for aspiration and exacerbation of lung diseases are depicted as contraindications for HFJV. Complications under HFJV are rare despite the limited conditions for monitoring gas exchange and mechanics of ventilation in contrast to conventional ventilation. A particular challenge for the anesthesiologist is the use of HFJV during laryngeal laser surgery.

The effects of high-frequency jet ventilation (HFJV) on pneumoperitoneum-induced cardiovascular changes during laparoscopic surgery

Standard mechanical ventilation may cause adverse cardiovascular effects in addition to those already related to positive-pressure pneumoperitoneum (PP) during laparoscopic surgery. High-frequency jet ventilation (HFJV) is associated with much less airway pressure, with potentially less influence on venous return, thus potentially it may reduce those effects. The aim of this study was to evaluate the benefits of HFJV to reduce the adverse cardiovascular effects during laparoscopic cholecystectomy. We conducted a randomized prospective trial, comparing 12 patients undergoing elective laparoscopic cholecystectomy under conventional mechanical ventilation (control) with 13 similar subjects under HFJV (study). Both groups were categorized as ASA I-II and underwent total intravenous anesthesia. Cardiac functionality was continuously evaluated by analysis of arterial pressure wave changes (Edwards Flo-Trac sensor and Vigileo monitor). There was no significant difference between both groups regarding age, gender, BMI, and general medical condition, as well as hemodynamic stability and blood gases throughout surgery. A significant reduction in cardiac output was noted in the control group under PP during the initiation of anti-Trendelenburg position (from 5.6 to 5.0 l/min, P = 0.049). A reciprocal change was observed regarding stroke volume. Such changes were not noticed under HFJV. Total peripheral resistance was significantly increased during PP, and heart rate was not significantly affected throughout surgery in both groups. Unexpectedly, we did not observe marked adverse hemodynamic changes in the control group during PP without position adjustment. The use of HFJV in upper laparoscopic surgery can impede the adverse cardiovascular changes that usually occur during induction of PP. We also suggest that the use of total intravenous anesthesia (as used in our study) may also lessen the cardiovascular impairment during PP.

The use of high frequency jet ventilation to treat suspected pulmonary hypoplasia

We report two cases of term male infants with suspected pulmonary hypoplasia, who could not be managed successfully with conventional mechanical ventilation. Both responded to rescue support with high frequency jet ventilation (HFJV) using an optimal positive end expiratory pressure strategy. One infant had the oligohydramnios sequence secondary to posterior urethral valves. The second infant was diagnosed prenatally with a severe right-sided congenital diaphragmatic hernia. We summarize the literature on the use of HFJV to support infants with severe pulmonary dysfunction. Unique air flow dynamics of HFJV may enable better gas exchange with less barotrauma, less volutrauma and ventilation at lower mean airway pressure. Our experience and the available literature suggest that HFJV appears to offer a unique advantage over conventional ventilation in such infants.

High-Frequency Jet Ventilation for Complete Target Immobilization and Reduction of Planning Target Volume in Stereotactic High Single-Dose Irradiation of Stage I Non–Small Cell Lung Cancer and Lung Metastases

To demonstrate the feasibility of complete target immobilization by means of high-frequency jet ventilation (HFJV); and to show that the saving of planning target volume (PTV) on the stereotactic body radiation therapy (SBRT) under HFJV, compared with SBRT with respiratory motion, can be predicted with reliable accuracy by computed tomography (CT) scans at peak inspiration phase. A comparison regarding different methods for defining the PTV was carried out in 22 patients with tumors that clearly moved with respiration. A movement span of the gross tumor volume (GTV) was defined by fusing respiration-correlated CT scans. The PTV enclosed the GTV positions with a safety margin throughout the breathing cycle. To create a PTV from CT scans acquired under HFJV, the same margins were drawn around the immobilized target. In addition, peak inspiration phase CT images (PIP-CTs) were used to approximate a target immobilized by HFJV. The resulting HFJV-PTVs were between 11.6% and 45.4% smaller than the baseline values calculated as respiration-correlated CT-PTVs (median volume reduction, 25.4%). Tentative planning by means of PIP-CT PTVs predicted that in 19 of 22 patients, use of HFJV would lead to a reduction in volume of >or=20%. Using this threshold yielded a positive predictive value of 0.89, as well as a sensitivity of 0.94 and a specificity of 0.5. In all patients, SBRT under HFJV provided a reliable immobilization of the GTVs and achieved a reduction in PTVs, regardless of patient compliance. Tentative planning facilitated the selection of patients who could better undergo radiation in respiratory standstill, both with greater accuracy and lung protection.

High-Frequency Jet Ventilation Rescue of an Off-Pump Single-Lung Transplant

HE AUTHORS REPORT the successful use of highfrequency jet ventilation (HFJV) during single-lung transplantation (SLTx) in a patient with bullous emphysema-induced inability to achieve adequate ventilation with pressure control ventilation. Jet ventilation improved gas exchange on one-lung ventilation (OLV), allowing for the completion of SLTx while avoiding the use of cardiopulmonary bypass (CPB).

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.

High-frequency jet ventilation: Utility in posterior left atrial catheter ablation

Percutaneous catheter ablation in the posterior left atrium (LA) is a technically demanding procedure that in our experience is best accomplished using general anesthesia, including endotracheal intubation and mechanical ventilation. However, using conventional intermittent positive-pressure ventilation (IPPV) technique, we were dissatisfied with motion of the posterior LA. This occurred during changes in lung volume, which destabilized ablation electrode-endocardial contact. We hypothesized that use of high-frequency jet ventilation (HFJV), a low-volume, fast-rate technique, would reduce posterior LA motion and thus facilitate the ablation procedure. The purpose of this study was to demonstrate that, relative to IPPV, HFJV reduces posterior LA motion and facilitates catheter ablation in this region. Patients who underwent posterior LA ablation using HFJV (n = 36) were retrospectively compared with those in whom IPPV (n = 36) was used. Indices examined included number of radiofrequency energy applications, electrode temperature, and procedure time. A prospective direct comparison of the impact of HFJV and IPPV on LA volume and mechanical function was performed in an additional 10 patients. Fewer ablation lesions were required in the HFJV group because of fewer incidences of ablation electrode dislodgment, resulting in significantly decreased procedure time. Although there was no significant difference in maximal electrode temperature achieved during radiofrequency application, temperature variation was diminished in the HFJV group. Direct comparison demonstrated that HFJV produced less variation in LA volume, pressure, pulmonary vein blood flow velocity, and posterior LA position than IPPV. Relative to IPPV, HFJV yields a more stable posterior LA environment, thus facilitating catheter ablation. Use of HFJV may be applicable to other interventional cardiovascular procedures.

Utilisation de la jet ventilation en pédiatrie

High frequency jet ventilation (HFJV) is an alternative ventilatory mode during anaesthesia for laryngeal microsurgery. This procedure ensures good visualization of the operating field but is not without risk. Thus, its use in paediatric patients requires sound knowledge of respiratory physiology of children and infants. In children up to 8 years, the jet ventilator adjustments must take into account the lower pulmonary compliance and the higher airway resistance (time-constant). In order to avoid barotrauma, which is the main HFJV complication, the jet ventilator has to include a monitoring airway pressure system. The driving pressure and the frequency must be gradually increased while checking thoracic expansion. Total intravenous anaesthesia with profound muscular relaxation using a thin transglottic catheter is the most commonly used technique. Standard monitoring of anaesthesia does not preclude strict clinical supervision so as to detect any pulmonary distension. The air-oxygen mixture must be adjusted to provide the lowest FIO 2 possible (≤ 30%) when using the CO 2 laser. The main indications for the use of HFJV in paediatric laryngeal microsurgery are laryngomalcia, laryngeal papillomatosis and subglottic haemangioma. HFJV is a reliable and useful technique in airway paediatric surgery providing the operator has good knowledge of the physiological particularities in children.