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Efficacy of Superimposed High Frequency Jet Ventilation and High Frequency Jet Ventilation in an Animal Model of Tracheal Obstruction
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, Hedenstierna laboratory.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Anaesthesiology and Intensive Care. Dipartimento di Elettronica, Informazione e Bioingegneria, Politecnico di Milano, Milan, Italy.
Dipartimento di Elettronica, Informazione e Bioingegneria, Politecnico di Milano, Milan, Italy.
Dipartimento di Elettronica, Informazione e Bioingegneria, Politecnico di Milano, Milan, Italy.
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2014 (English)In: Anesthesiology, ISSN 0003-3022, E-ISSN 1528-1175Article in journal (Refereed) Submitted
Abstract [en]

Background

Superimposed high frequency jet ventilation (SHFJV) and high-frequency jet ventilation (HJFV) are widely used for airway interventions using rigid bronchoscopy. SHFJV was found to provide higher lung volume and better gas exchange than HFJV in unobstructed airways.

We hypothesized that, also in the presence of airway obstruction, SHFJV would provide higher lung volumes, better oxygenation and more effective CO2 removal than HFJV.

Methods

In a porcine model, we used a stent with ID 4 mm to create tracheal obstruction. The anesthetized animals (25-31.5kg) were alternately ventilated with SHFJV (low frequency 16min-1, combined with a high frequency fHF) and HFJV (solely fHF) at a set of different fHF from 50-600min-1. Chest wall volume changes were measured with opto-electronic plethysmography, airway pressures were registered continuously and arterial blood gases were obtained repeatedly.

Results

SHFJV provided higher ∆EEVCW than HFJV with a difference between both modes of 129 ml (fHF=50min-1) to 62 ml (fHF=400min-1). Tidal volume (VT) was always greater than 213 ml with SHFJV, but with HFJV, increasing fHF reduced VT from 112 (97-130) ml at fHF=50 min-1 to negligible values at fHF>150 min-1.

In analogy, SHFJV provided paO2 of >30 kPa and acceptable CO2 removal for all fHF, whereas fHF>150 min-1 resulted in severe hypoxia and hypercarbia during HFJV.

Conclusion

SHFJV effectively increased lung volumes and maintained gas exchange compared with HFJV. SHFJV may be a safer option than HFJV in laser surgery, where low FiO2 is required. HFJV with frequencies >100-150 min-1 should not be used in severe airway obstruction.

Place, publisher, year, edition, pages
2014.
Keyword [en]
jet ventilation, airway obstruction, tracheal stenosis, HFJV, SHFJV
National Category
Anesthesiology and Intensive Care
Research subject
Anaesthesiology and Intensive Care
Identifiers
URN: urn:nbn:se:uu:diva-229060OAI: oai:DiVA.org:uu-229060DiVA: diva2:735504
Funder
Swedish Research CouncilSwedish Heart Lung Foundation
Available from: 2014-07-28 Created: 2014-07-28 Last updated: 2017-12-05Bibliographically 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.
Series
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 1014
Keyword
jet ventilation, airway obstruction, tracheal stenosis, HFJV, SHFJV
National Category
Anesthesiology and Intensive Care
Research subject
Anaesthesiology and Intensive Care
Identifiers
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)
Opponent
Supervisors
Funder
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, RobertLo Mauro, AntonellaFrykholm, PeterLarsson, Anders

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