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Frequency dependence of lung volume changes during superimposed high-frequency jet ventilation and high-frequency jet ventilation
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.
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2014 (English)In: British Journal of Anaesthesia, ISSN 0007-0912, E-ISSN 1471-6771, Vol. 112, no 1, 141-149 p.Article in journal (Refereed) Published
Abstract [en]

Background. Superimposed high-frequency jet ventilation (SHFJV) has proved to be safe and effective in clinical practice. However, it is unclear which frequency range optimizes ventilation and gas exchange. The aim of this study was to systematically compare high-frequency jet ventilation (HFJV) with HFJV by assessing chest wall volume variations (Delta EEVCW) and gas exchange in relation to variable high frequency. 

Methods. SHFJV or HFJV were used alternatively to ventilate the lungs of 10 anaesthetized pigs (21-25 kg). The low-frequency component was kept at 16 min(-1) in SHFJV. In both modes, high frequencies ranging from 100 to 1000 min(-1) were applied in random order and ventilation was maintained for 5 min in all modalities. Chest wall volume variations were obtained using opto-electronic plethysmography. Airway pressures and arterial blood gases were measured repeatedly. 

Results. SHFJV increased Delta EEVCW compared with HFJV; the difference ranged from 43 to 68 ml. Tidal volume (V-T) was always >240 ml during SHFJV whereas during HFJV ranged from 92 ml at theventilation frequency of 100 min(-1) to negligible values at frequencies >300 min(-1). We observed similar patterns for Pa-O2 and Pa-CO2. SHFJV provided generally higher, frequency-independent oxygenation (Pa-O2 at least 32.0 kPa) and CO2 removal (Pa-CO2 similar to 5.5 kPa), whereas HFJV led to hypoxia and hypercarbia at higher rates (Pa-O2 < 10 kPa and Pa-CO2 > 10 kPa at f(HF) > 300 min(-1)). 

Conclusions. In a porcine model, SHFJV was more effective in increasing end-expiratory volume than single-frequency HFJV, but both modes may provide adequate ventilation in the absence of airway obstruction and respiratory disease, except for HFJV at frequencies >= 300 min(-1).

Place, publisher, year, edition, pages
2014. Vol. 112, no 1, 141-149 p.
National Category
Medical and Health Sciences
URN: urn:nbn:se:uu:diva-212347DOI: 10.1093/bja/aet260ISI: 000328404700021PubMedID: 23963714OAI: oai:DiVA.org:uu-212347DiVA: diva2:677041
Available from: 2013-12-09 Created: 2013-12-09 Last updated: 2014-09-08Bibliographically 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

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Sütterlin, RobertLarsson, AndersFrykholm, Peter
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