uu.seUppsala University Publications
Change search
ReferencesLink to record
Permanent link

Direct link
Comparison of superimposed high-frequency jet ventilation with conventional jet ventilation for laryngeal surgery
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Anaesthesiology and Intensive Care.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Anaesthesiology and Intensive Care.
Show others and affiliations
2012 (English)In: British Journal of Anaesthesia, ISSN 0007-0912, E-ISSN 1471-6771, Vol. 108, no 4, 690-697 p.Article in journal (Refereed) Published
Abstract [en]


New ventilators have simplified the use of supraglottic superimposed high-frequency jet ventilation (SHFJVSG), but it has not been systematically compared with other modes of jet ventilation (JV) in humans. We sought to investigate whether SHFJVSG would provide more effective ventilation compared with single-frequency JV techniques.


A total of 16 patients undergoing minor laryngeal surgery under general anaesthesia were included. In each patient, four different JV techniques were applied in random order for 10-min periods: SHFJVSG, supraglottic normal frequency (NFJVSG), supraglottic high frequency (HFJVSG), and infraglottic high-frequency jet ventilation (HFJVIG).

Chest wall volume variations were continuously measured with opto-electronic plethysmography (OEP), intratracheal pressure was recorded and blood gases were measured.


Chest wall volumes were normalized to NFJVSG end-expiratory level. The increase in end-expiratory chest wall volume (EEVCW) was 239 (196) ml during SHFJVSG (P<0.05 compared with NFJVSG). EEVCW was 148 (145) and 44 (106) ml during HFJVSG and HFJVIG, respectively (P<0.05 compared with SHFJVSG). Tidal volume (VT) during SHFJVSG was 269 (149) ml. VT was 229 (169) ml (P=1.00 compared with SHFJVSG), 145 (50) ml (P<0.05), and 110 (33) ml (P<0.01) during NFJVSG, HFJVSG, and HFJVIG, respectively.

Intratracheal pressures corresponded well to changes in both EEVCW and VT. All JV modes resulted in adequate oxygenation. However, PACO2was lowest during HFJVSG [4.3 (1.3) kPa; P<0.01 compared with SHFJVSG].


SHFJVSG was associated with increased EEVCW and VT compared with the three other investigated JV modes. All four modes provided adequate ventilation and oxygenation, and thus can be used for uncomplicated laryngeal surgery in healthy patients with limited airway obstruction.

Place, publisher, year, edition, pages
2012. Vol. 108, no 4, 690-697 p.
National Category
Medical and Health Sciences
URN: urn:nbn:se:uu:diva-168896DOI: 10.1093/bja/aer460ISI: 000302016600021PubMedID: 22258205OAI: oai:DiVA.org:uu-168896DiVA: diva2:503916
Available from: 2012-02-17 Created: 2012-02-17 Last updated: 2015-06-24Bibliographically approved
In thesis
1. Jet Ventilation for Airway Surgery: The Influence of Mode and Frequency on Ventilation Efficacy
Open this publication in new window or tab >>Jet Ventilation for Airway Surgery: The Influence of Mode and Frequency on Ventilation Efficacy
2014 (English)Doctoral thesis, comprehensive summary (Other academic)
Alternative title[sv]
Jet ventilation vid luftvägskirurgi : Betydelse av ventilationsmode och frekvens for ventilationens effektivitet
Abstract [en]

In surgery for airway obstruction, the anesthetist and the ear-nose-throat surgeon share the approach to the airway and jet ventilation (JV) is a mutually convenient ventilation technique for both parties. As a consequence of the open system jet ventilation is applied in, bedside measurements of lung volumes are cumbersome to perform and thus, there is a lack of studies comparing different modes of JV or investigating the influence of ventilator settings on lung volumes and gas exchange. In this thesis, single frequency jet ventilation and superimposed high frequency jet ventilation (SHFJV) at different frequencies are systematically compared with respect to lung volume changes, underlying airway pressure variations and the resulting gas exchange.

We compared three single-frequency JV modalities with SHFJV in patients. Moreover, we performed a systematic investigation of single frequency JV and SHFJV in a porcine model. Single frequency JV and SHFJV were compared frequency-wise in intact airways and in a newly developed model of tracheal obstruction. This model was also used to assess the influence of variable airway diameter on ventilation effectiveness during SHFJV. We measured chest wall volume variations with opto-electronic plethysmography and obtained airway pressures as well as gas exchange parameters.

In unobstructed airways, both single-frequency JV and SHFJV provided adequate oxygenation, despite differences in lung volumes. Carbon dioxide removal was most effective using single frequency JV at a frequency of 150 min-1. During SHFJV, for both intact and obstructed airways, the choice of frequency for the high frequency component had little influence on lung volumes, airway pressures and gas exchange. With decreasing airway diameter and SHFJV, we observed air trapping and lower tidal volumes and acceptable oxygenation. Carbon dioxide removal, however, was insufficient at the narrowest airway diameter. In single frequency JV, very high frequencies resulted in negligible tidal volume and inacceptable gas exchange. Airway obstruction potentiated this frequency dependence.

In conclusion, in intact airways, single frequency JV at sufficiently low frequencies provided adequate oxygenation and better CO2 removal than SHFJV. With decreasing airway diameter, SHFJV provided better oxygenation and CO2 removal and may therefore be the mode of choice in more complicated cases.

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2014. 62 p.
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 1014
jet ventilation, airway obstruction, tracheal stenosis, HFJV, SHFJV
National Category
Anesthesiology and Intensive Care
Research subject
Anaesthesiology and Intensive Care
urn:nbn:se:uu:diva-229033 (URN)978-91-554-8984-7 (ISBN)
Public defence
2014-09-12, Gunnesalen, Psykiatrins hus, Akademiska sjukhuset, Uppsala, 13:00 (English)
Swedish Heart Lung FoundationSwedish Research Council
Available from: 2014-08-20 Created: 2014-07-28 Last updated: 2014-09-10

Open Access in DiVA

No full text

Other links

Publisher's full textPubMed

Search in DiVA

By author/editor
Leiter, RobertStaun, PhilipLo Mauro, AntonellaLarsson, AndersFrykholm, Peter
By organisation
Anaesthesiology and Intensive Care
In the same journal
British Journal of Anaesthesia
Medical and Health Sciences

Search outside of DiVA

GoogleGoogle Scholar

Altmetric score

Total: 369 hits
ReferencesLink to record
Permanent link

Direct link