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Influence of Tracheal Obstruction on the Efficacy of Superimposed High-frequency Jet Ventilation and Single-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, Hedenstierna laboratory.
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.
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2015 (English)In: Anesthesiology, ISSN 0003-3022, E-ISSN 1528-1175, Vol. 123, no 10, 799-809 p., doi:10.1097/ALN.0000000000000818Article in journal (Refereed) Published
Abstract [en]

Background

Superimposed high frequency jet ventilation (SHFJV) has been used successfully in selected patients with severe central airway obstruction undergoing airway interventions.

We sought to systematically describe the efficacy of SHFJV in relation to obstruction and the high frequency component (fHF) in a model of tracheal stenosis.

Methods

Ten anesthetized animals (25-31.5kg) were alternately ventilated with SHFJV (low frequency 16min-1, random fHF) at a set of different fHF from 50-600min-1. Tracheal obstruction was created using exchangeable stents with different inner diameter (2, 4, 6, 8mm) that were inserted into the trachea. Chest wall volume was measured using optoelectronic plethysmography, airway pressures were recorded and blood gases were analyzed repeatedly.

Results

Stent ID reduction from 8 to 2mm resulted in an increase of ∆EEVCW by up to 3x (e.g. 323 [255 - 410] ml vs 106 [81 - 138] ml at fHF=100 min-1). At the same time, VT decreased by up to 4.2x (e.g. 477 [434 – 524] ml vs 114 [79 – 165] ml). PaO2 and paCO2 remained at acceptable levels for 4-8 mm stent ID but CO2 removal became suddenly impaired at 2mm stent ID (paCO2>12 kPa). Pre-stenotic airway pressure monitoring was accurate at 8mm stent ID, but overestimation of peak inspiratory pressure (PIP) up to 2x and underestimation of PEEP up to 19x was observed at 2mm stent ID.

Conclusion

SHFJV was able to maintain oxygenation and carbon dioxide removal over a wide range of obstructions, despite decreasing VT and successive air trapping. At 2 mm stent ID, only carbon dioxide removal became insufficient.

Place, publisher, year, edition, pages
2015. Vol. 123, no 10, 799-809 p., doi:10.1097/ALN.0000000000000818
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-229061OAI: oai:DiVA.org:uu-229061DiVA: diva2:735506
Funder
Swedish Research CouncilSwedish Heart Lung Foundation
Available from: 2014-07-28 Created: 2014-07-28 Last updated: 2017-12-05
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, RobertFrykholm, PeterLo Mauro, AntonellaLarsson, Anders

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