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Alexander Aloy - One of the best experts on this subject based on the ideXlab platform.
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supraglottic combined frequency Jet Ventilation versus subglottic monofrequent Jet Ventilation in patients undergoing microlaryngeal surgery
Anesthesia & Analgesia, 2000Co-Authors: Andreas Bacher, Karin Pichler, Alexander AloyAbstract:UNLABELLED: We compared the efficacy of gas exchange during supraglottic combined-frequency Jet Ventilation via a Jet Ventilation laryngoscope and during monofrequent Jet Ventilation via the Mon-Jet catheter (Xomed, Jacksonville, FL). Twenty-three anesthetized (propofol, fentanyl, vecuronium) patients undergoing microlaryngeal surgery were prospectively studied and randomly assigned to one of two groups. The patients' lungs were ventilated with combined-frequency Jet Ventilation (10 min, 15 and 600 breaths/min, inspiration/expiration time ratio = 1, driving pressure 750-1500 mm Hg), monofrequent (low-frequency group: 15 breaths/min; high-frequency group: 600 breaths/min) Jet Ventilation (20 min), and again combined-frequency Jet Ventilation (15 min). PaO(2), PaCO(2), and the inspiratory oxygen fraction (FIO(2)) were measured. Wilcoxon's signed rank test was applied. During monofrequent Jet Ventilation, PaCO(2) increased and the PaO(2)/FIO(2) decreased significantly (P < 0.05) as compared with combined-frequency Jet Ventilation (low-frequency group: PaCO(2) from 39.4 +/- 3.3 to 50. 8 +/- 8.0 mm Hg, PaO(2)/FIO(2) from 306 +/- 100 to 225 +/- 94 mm Hg; high-frequency group: PaCO(2) from 36.7 +/- 7.2 to 60.3 +/- 6.1 mm Hg, PaO(2)/FIO(2) from 429 +/- 87 to 190 +/- 51 mm Hg; mean +/- SD). After switching back to combined-frequency Jet Ventilation, PaCO(2) decreased and PaO(2)/FIO(2) increased to baseline levels. We conclude that gas exchange during microlaryngeal surgery can be more easily maintained with supraglottic combined-frequency Jet Ventilation than with subglottic monofrequent Jet Ventilation via the Mon-Jet catheter. IMPLICATIONS: This study demonstrates that the combination of high- and low-frequency supraglottic Jet Ventilation via a Jet Ventilation laryngoscope provides a better pulmonary gas exchange and allows more accurate airway pressure monitoring during microlaryngeal surgery than subglottic monofrequent Jet Ventilation via an endotracheal catheter.
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Supraglottic combined frequency Jet Ventilation versus subglottic monofrequent Jet Ventilation in patients undergoing microlaryngeal surgery.
Anesthesia and analgesia, 2000Co-Authors: Andreas Bacher, Karin Pichler, Alexander AloyAbstract:We compared the efficacy of gas exchange during supraglottic combined-frequency Jet Ventilation via a Jet Ventilation laryngoscope and during monofrequent Jet Ventilation via the Mon-Jet catheter (Xomed, Jacksonville, FL). Twenty-three anesthetized (propofol, fentanyl, vecuronium) patients undergoing microlaryngeal surgery were prospectively studied and randomly assigned to one of two groups. The patients' lungs were ventilated with combined-frequency Jet Ventilation (10 min, 15 and 600 breaths/min, inspiration/expiration time ratio = 1, driving pressure 750-1500 mm Hg), monofrequent (low-frequency group: 15 breaths/min; high-frequency group: 600 breaths/min) Jet Ventilation (20 min), and again combined-frequency Jet Ventilation (15 min). PaO(2), PaCO(2), and the inspiratory oxygen fraction (FIO(2)) were measured. Wilcoxon's signed rank test was applied. During monofrequent Jet Ventilation, PaCO(2) increased and the PaO(2)/FIO(2) decreased significantly (P < 0.05) as compared with combined-frequency Jet Ventilation (low-frequency group: PaCO(2) from 39.4 +/- 3.3 to 50. 8 +/- 8.0 mm Hg, PaO(2)/FIO(2) from 306 +/- 100 to 225 +/- 94 mm Hg; high-frequency group: PaCO(2) from 36.7 +/- 7.2 to 60.3 +/- 6.1 mm Hg, PaO(2)/FIO(2) from 429 +/- 87 to 190 +/- 51 mm Hg; mean +/- SD). After switching back to combined-frequency Jet Ventilation, PaCO(2) decreased and PaO(2)/FIO(2) increased to baseline levels. We conclude that gas exchange during microlaryngeal surgery can be more easily maintained with supraglottic combined-frequency Jet Ventilation than with subglottic monofrequent Jet Ventilation via the Mon-Jet catheter. This study demonstrates that the combination of high- and low-frequency supraglottic Jet Ventilation via a Jet Ventilation laryngoscope provides a better pulmonary gas exchange and allows more accurate airway pressure monitoring during microlaryngeal surgery than subglottic monofrequent Jet Ventilation via an endotracheal catheter.
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High-frequency Jet Ventilation in European and North American institutions: developments and clinical practice.
European journal of anaesthesiology, 2000Co-Authors: G. Ihra, G. Gockner, A. Kashanipour, Alexander AloyAbstract:Respiratory support with high-frequency Jet Ventilation has been advocated during airway surgery or to improve pulmonary mechanics and gas exchange in patients with bronchopleural fistulae or pulmonary insufficiency. Despite a large body of published evidence describing its benefits as an alternative ventilatory approach in anaesthesia and intensive care medicine, its application has not gained widespread acceptance and is restricted to specialized centres. To review the literature on high-frequency Jet Ventilation in European and North American institutions, we performed a search in a computerized database (MEDLINE) covering the period from 1990 until the present time, describing the use of high-frequency Jet Ventilation in over 7000 patients. Various modes to apply high-frequency Jet Ventilation during airway surgery have been established, but its value in intensive care is controversial. We report our experience with combined high-frequency Jet Ventilation and provide guidelines for its safe application.
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Respiratory efficacy of subglottic low-frequency, subglottic combined-frequency, and supraglottic combined-frequency Jet Ventilation during microlaryngeal surgery.
Anesthesia and analgesia, 2000Co-Authors: Andreas Bacher, Thomas Lang, Johannes Weber, Alexander AloyAbstract:We tested the respiratory efficacy of different Jet Ventilation techniques (subglottic low-frequency versus subglottic combined-frequency and subglottic combined-frequency versus supraglottic combined frequency) in patients undergoing microlaryngeal surgery. The PaCO(2) and the quotient of arterial oxygen tension (PaO(2)) over FIO(2) were measured. After anesthetic induction (propofol, remifentanil, vecuronium), an endotracheal Mon-Jet catheter (Xomed, Jacksonville, FL) for subglottic Jet Ventilation and a laryngoscope for supraglottic Jet Ventilation (Carl Reiner G.m.b.H., Vienna, Austria) were inserted. In Group 1 (n = 18), subglottic low-frequency (15 breaths/min), combined-frequency (600 and 15 breaths/min), and low-frequency Jet Ventilation was subsequently performed (15 min each). In Group 2 (n = 19), the sequence was supraglottic, subglottic, and supraglottic combined-frequency Jet Ventilation. The driving pressures were initially adjusted to achieve normocapnia and were not changed during the entire study period. The FIO(2) was measured endotracheally. The Wilcoxon's signed rank test was applied. In Group 1, PaCO(2) and PaO(2)/FIO(2) improved significantly after switching from subglottic low-frequency to subglottic combined-frequency Jet Ventilation (PaCO(2), from 46.6 +/-8.3 to 42.1+/-8.1 mm Hg; PaO(2)/FIO(2), from 311+/-144 to 361+/-141 mm Hg; P<0.05). In Group 2, PaCO(2) increased and PaO(2)/FIO(2) decreased significantly after switching from supraglottic to subglottic combined-frequency Jet Ventilation (PaCO(2), from 39.4+/-7.1 to 45.9+/-7.5 mm Hg; PaO(2)/FIO(2), from 415+/-114 to 351+/-129 mm Hg; P<0.05). We conclude that subglottic combined-frequency Jet Ventilation is less effective than supraglottic combined-frequency Ventilation, but more effective than subglottic low-frequency Jet Ventilation. The combination of high and low respiratory frequencies (600 and 15 breaths/min) improves pulmonary gas exchange during subglottic Jet Ventilation via an endotracheal catheter. However, subglottic combined-frequency Jet Ventilation is less effective than supraglottic combined-frequency Jet Ventilation via a Jet Ventilation laryngoscope.
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Tubeless laryngotracheal surgery in infants and children via Jet Ventilation laryngoscope.
The Laryngoscope, 1997Co-Authors: Matthaeus Ch. Grasl, A. Donner, Eva Schragl, Alexander AloyAbstract:We present the first use of tubeless superimposed combined high- and low-frequency Jet Ventilation (SHFJV) with a Jet laryngoscope in laryngotracheal surgery in infants and children. Twenty-eight patients underwent 53 operative procedures. The average age of the patients was 7.3 years. The most common diagnoses were laryngeal papillomatosis and subglottic stenosis. The duration of Jet Ventilation averaged 33 min. The gas exchange was sufficient in each case. The advantages of SHFJV in the surgery of the laryngotracheal area in infants and children are optimal view at the larynx and trachea, maximum space for the handling, application of the laser without risks, no time limitation, suitability for stenosis, and neither anesthetic nor surgical complications.
Laura Matrka - One of the best experts on this subject based on the ideXlab platform.
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Airway Surgery Communication Protocol: A Quality Initiative for Safe Performance of Jet Ventilation.
The Laryngoscope, 2019Co-Authors: Laura Matrka, Brad W. Desilva, Liuba Soldatova, Daniel TraetowAbstract:OBJECTIVES To assess whether manual Jet Ventilation can safely be performed with variable anesthesia and operating room (OR) staff experience levels and communication skills. METHODS Jet Ventilation procedures for airway stenosis at a single institution over 35 months were retrospectively reviewed. OR and anesthesia staff were assigned scores based on experience level and communication skills. Data were analyzed for any association between the experience or communication skills of the staff and the successful use of Jet Ventilation, complication rate, or ultimate patient outcome, controlling for intraoperative variables and patient and airway complexity. A detailed preoperative surgeon-led communication protocol was followed in all cases. RESULTS Seventy procedures in 46 patients were performed. Jet Ventilation was successful in 69 of 70 cases. No relationship was found between staff experience or communication scores and the successful use of Jet Ventilation, complication rate, or ultimate patient outcome. The percentage of cases performed with a fully experienced team was low, at 7.1%. The experience level of the certified registered nurse anesthetist was significantly associated with likelihood of using an adequate paralytic dose upfront (P = 0.017), which in turn correlated with shorter anesthesia time by 19.7 minutes (P = 0.0131); however, neither affected complication rate nor ultimate patient outcome. The statements above remained true in cases of medically complex patients, difficult airways with high degrees of stenosis, and multiple shift changes. CONCLUSIONS Manual Jet Ventilation can be performed safely even in settings of lower staff experience level or communication skills given a surgeon experienced in the technique and a strict communication protocol. LEVEL OF EVIDENCE 4 Laryngoscope, 130:S1-S13, 2020.
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Airway Surgery Communication Protocol: A Quality Initiative for Safe Performance of Jet Ventilation.
The Laryngoscope, 2019Co-Authors: Laura Matrka, Brad W. Desilva, Liuba Soldatova, Daniel TraetowAbstract:To assess whether manual Jet Ventilation can safely be performed with variable anesthesia and operating room (OR) staff experience levels and communication skills. Jet Ventilation procedures for airway stenosis at a single institution over 35 months were retrospectively reviewed. OR and anesthesia staff were assigned scores based on experience level and communication skills. Data were analyzed for any association between the experience or communication skills of the staff and the successful use of Jet Ventilation, complication rate, or ultimate patient outcome, controlling for intraoperative variables and patient and airway complexity. A detailed preoperative surgeon-led communication protocol was followed in all cases. Seventy procedures in 46 patients were performed. Jet Ventilation was successful in 69 of 70 cases. No relationship was found between staff experience or communication scores and the successful use of Jet Ventilation, complication rate, or ultimate patient outcome. The percentage of cases performed with a fully experienced team was low, at 7.1%. The experience level of the certified registered nurse anesthetist was significantly associated with likelihood of using an adequate paralytic dose upfront (P = 0.017), which in turn correlated with shorter anesthesia time by 19.7 minutes (P = 0.0131); however, neither affected complication rate nor ultimate patient outcome. The statements above remained true in cases of medically complex patients, difficult airways with high degrees of stenosis, and multiple shift changes. Manual Jet Ventilation can be performed safely even in settings of lower staff experience level or communication skills given a surgeon experienced in the technique and a strict communication protocol. 4 Laryngoscope, 130:S1-S13, 2020. © 2019 The American Laryngological, Rhinological and Otological Society, Inc.
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Jet Ventilation in obese patients undergoing airway surgery for subglottic and tracheal stenosis
Laryngoscope, 2018Co-Authors: Ramez Philips, Brad W. Desilva, Laura MatrkaAbstract:OBJECTIVES/HYPOTHESIS To assess the feasibility of Jet Ventilation in obese patients and to compare complications of Jet Ventilation in obese and nonobese patients. STUDY DESIGN Retrospective review of medical records. METHODS We reviewed 46 patient charts (70 procedures) with the diagnosis of tracheal or subglottic stenosis who underwent endoscopic surgery with Jet Ventilation between March 2014 and January 2017. Adequacy of Jet Ventilation was assessed by chest rise, avoidance of endotracheal intubation, and length of case and Ventilation. Records were reviewed for demographic details, anesthesia records, and complications. RESULTS In 29/70 (41.4%) of cases, patients were obese; in 9/29 (31.0%) of these cases, patients were morbidly obese. Jet Ventilation was successful in 28/29 (97%) of obese cases. In 1/29 (3.4%) of cases, the patient required alternative airway management. There were no significant differences between obese and nonobese patients in chest rise, need for endotracheal intubation, and length of surgery or Ventilation (P > .05). There were 2/29 (6.9%) cases of intra- and postoperative complications including laryngospasm (1/29, 3.4%) and tachycardia (1/29, 3.4%). Rate of complications did not differ between obese and nonobese patients (P = .178). CONCLUSIONS Jet Ventilation in obese patients can be done successfully, and complications are similar between obese patients and nonobese patients. LEVEL OF EVIDENCE 4. Laryngoscope, 1887-1892, 2018.
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Jet Ventilation in obese patients undergoing airway surgery for subglottic and tracheal stenosis
The Laryngoscope, 2017Co-Authors: Ramez Philips, Brad W. Desilva, Laura MatrkaAbstract:To assess the feasibility of Jet Ventilation in obese patients and to compare complications of Jet Ventilation in obese and nonobese patients. Retrospective review of medical records. We reviewed 46 patient charts (70 procedures) with the diagnosis of tracheal or subglottic stenosis who underwent endoscopic surgery with Jet Ventilation between March 2014 and January 2017. Adequacy of Jet Ventilation was assessed by chest rise, avoidance of endotracheal intubation, and length of case and Ventilation. Records were reviewed for demographic details, anesthesia records, and complications. In 29/70 (41.4%) of cases, patients were obese; in 9/29 (31.0%) of these cases, patients were morbidly obese. Jet Ventilation was successful in 28/29 (97%) of obese cases. In 1/29 (3.4%) of cases, the patient required alternative airway management. There were no significant differences between obese and nonobese patients in chest rise, need for endotracheal intubation, and length of surgery or Ventilation (P > .05). There were 2/29 (6.9%) cases of intra- and postoperative complications including laryngospasm (1/29, 3.4%) and tachycardia (1/29, 3.4%). Rate of complications did not differ between obese and nonobese patients (P = .178). Jet Ventilation in obese patients can be done successfully, and complications are similar between obese patients and nonobese patients. 4. Laryngoscope, 1887-1892, 2018. © 2017 The American Laryngological, Rhinological and Otological Society, Inc.
Andreas Bacher - One of the best experts on this subject based on the ideXlab platform.
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supraglottic combined frequency Jet Ventilation versus subglottic monofrequent Jet Ventilation in patients undergoing microlaryngeal surgery
Anesthesia & Analgesia, 2000Co-Authors: Andreas Bacher, Karin Pichler, Alexander AloyAbstract:UNLABELLED: We compared the efficacy of gas exchange during supraglottic combined-frequency Jet Ventilation via a Jet Ventilation laryngoscope and during monofrequent Jet Ventilation via the Mon-Jet catheter (Xomed, Jacksonville, FL). Twenty-three anesthetized (propofol, fentanyl, vecuronium) patients undergoing microlaryngeal surgery were prospectively studied and randomly assigned to one of two groups. The patients' lungs were ventilated with combined-frequency Jet Ventilation (10 min, 15 and 600 breaths/min, inspiration/expiration time ratio = 1, driving pressure 750-1500 mm Hg), monofrequent (low-frequency group: 15 breaths/min; high-frequency group: 600 breaths/min) Jet Ventilation (20 min), and again combined-frequency Jet Ventilation (15 min). PaO(2), PaCO(2), and the inspiratory oxygen fraction (FIO(2)) were measured. Wilcoxon's signed rank test was applied. During monofrequent Jet Ventilation, PaCO(2) increased and the PaO(2)/FIO(2) decreased significantly (P < 0.05) as compared with combined-frequency Jet Ventilation (low-frequency group: PaCO(2) from 39.4 +/- 3.3 to 50. 8 +/- 8.0 mm Hg, PaO(2)/FIO(2) from 306 +/- 100 to 225 +/- 94 mm Hg; high-frequency group: PaCO(2) from 36.7 +/- 7.2 to 60.3 +/- 6.1 mm Hg, PaO(2)/FIO(2) from 429 +/- 87 to 190 +/- 51 mm Hg; mean +/- SD). After switching back to combined-frequency Jet Ventilation, PaCO(2) decreased and PaO(2)/FIO(2) increased to baseline levels. We conclude that gas exchange during microlaryngeal surgery can be more easily maintained with supraglottic combined-frequency Jet Ventilation than with subglottic monofrequent Jet Ventilation via the Mon-Jet catheter. IMPLICATIONS: This study demonstrates that the combination of high- and low-frequency supraglottic Jet Ventilation via a Jet Ventilation laryngoscope provides a better pulmonary gas exchange and allows more accurate airway pressure monitoring during microlaryngeal surgery than subglottic monofrequent Jet Ventilation via an endotracheal catheter.
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Supraglottic combined frequency Jet Ventilation versus subglottic monofrequent Jet Ventilation in patients undergoing microlaryngeal surgery.
Anesthesia and analgesia, 2000Co-Authors: Andreas Bacher, Karin Pichler, Alexander AloyAbstract:We compared the efficacy of gas exchange during supraglottic combined-frequency Jet Ventilation via a Jet Ventilation laryngoscope and during monofrequent Jet Ventilation via the Mon-Jet catheter (Xomed, Jacksonville, FL). Twenty-three anesthetized (propofol, fentanyl, vecuronium) patients undergoing microlaryngeal surgery were prospectively studied and randomly assigned to one of two groups. The patients' lungs were ventilated with combined-frequency Jet Ventilation (10 min, 15 and 600 breaths/min, inspiration/expiration time ratio = 1, driving pressure 750-1500 mm Hg), monofrequent (low-frequency group: 15 breaths/min; high-frequency group: 600 breaths/min) Jet Ventilation (20 min), and again combined-frequency Jet Ventilation (15 min). PaO(2), PaCO(2), and the inspiratory oxygen fraction (FIO(2)) were measured. Wilcoxon's signed rank test was applied. During monofrequent Jet Ventilation, PaCO(2) increased and the PaO(2)/FIO(2) decreased significantly (P < 0.05) as compared with combined-frequency Jet Ventilation (low-frequency group: PaCO(2) from 39.4 +/- 3.3 to 50. 8 +/- 8.0 mm Hg, PaO(2)/FIO(2) from 306 +/- 100 to 225 +/- 94 mm Hg; high-frequency group: PaCO(2) from 36.7 +/- 7.2 to 60.3 +/- 6.1 mm Hg, PaO(2)/FIO(2) from 429 +/- 87 to 190 +/- 51 mm Hg; mean +/- SD). After switching back to combined-frequency Jet Ventilation, PaCO(2) decreased and PaO(2)/FIO(2) increased to baseline levels. We conclude that gas exchange during microlaryngeal surgery can be more easily maintained with supraglottic combined-frequency Jet Ventilation than with subglottic monofrequent Jet Ventilation via the Mon-Jet catheter. This study demonstrates that the combination of high- and low-frequency supraglottic Jet Ventilation via a Jet Ventilation laryngoscope provides a better pulmonary gas exchange and allows more accurate airway pressure monitoring during microlaryngeal surgery than subglottic monofrequent Jet Ventilation via an endotracheal catheter.
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Respiratory efficacy of subglottic low-frequency, subglottic combined-frequency, and supraglottic combined-frequency Jet Ventilation during microlaryngeal surgery.
Anesthesia and analgesia, 2000Co-Authors: Andreas Bacher, Thomas Lang, Johannes Weber, Alexander AloyAbstract:We tested the respiratory efficacy of different Jet Ventilation techniques (subglottic low-frequency versus subglottic combined-frequency and subglottic combined-frequency versus supraglottic combined frequency) in patients undergoing microlaryngeal surgery. The PaCO(2) and the quotient of arterial oxygen tension (PaO(2)) over FIO(2) were measured. After anesthetic induction (propofol, remifentanil, vecuronium), an endotracheal Mon-Jet catheter (Xomed, Jacksonville, FL) for subglottic Jet Ventilation and a laryngoscope for supraglottic Jet Ventilation (Carl Reiner G.m.b.H., Vienna, Austria) were inserted. In Group 1 (n = 18), subglottic low-frequency (15 breaths/min), combined-frequency (600 and 15 breaths/min), and low-frequency Jet Ventilation was subsequently performed (15 min each). In Group 2 (n = 19), the sequence was supraglottic, subglottic, and supraglottic combined-frequency Jet Ventilation. The driving pressures were initially adjusted to achieve normocapnia and were not changed during the entire study period. The FIO(2) was measured endotracheally. The Wilcoxon's signed rank test was applied. In Group 1, PaCO(2) and PaO(2)/FIO(2) improved significantly after switching from subglottic low-frequency to subglottic combined-frequency Jet Ventilation (PaCO(2), from 46.6 +/-8.3 to 42.1+/-8.1 mm Hg; PaO(2)/FIO(2), from 311+/-144 to 361+/-141 mm Hg; P<0.05). In Group 2, PaCO(2) increased and PaO(2)/FIO(2) decreased significantly after switching from supraglottic to subglottic combined-frequency Jet Ventilation (PaCO(2), from 39.4+/-7.1 to 45.9+/-7.5 mm Hg; PaO(2)/FIO(2), from 415+/-114 to 351+/-129 mm Hg; P<0.05). We conclude that subglottic combined-frequency Jet Ventilation is less effective than supraglottic combined-frequency Ventilation, but more effective than subglottic low-frequency Jet Ventilation. The combination of high and low respiratory frequencies (600 and 15 breaths/min) improves pulmonary gas exchange during subglottic Jet Ventilation via an endotracheal catheter. However, subglottic combined-frequency Jet Ventilation is less effective than supraglottic combined-frequency Jet Ventilation via a Jet Ventilation laryngoscope.
Peter Frykholm - One of the best experts on this subject based on the ideXlab platform.
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Influence of Tracheal Obstruction on the Efficacy of Superimposed High-frequency Jet Ventilation and Single-frequency Jet Ventilation
Anesthesiology, 2015Co-Authors: Robert Sütterlin, Andrea Aliverti, Rita Priori, Peter Frykholm, Antonella Lomauro, Stefano Gandolfi, Anders LarssonAbstract: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.
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Comparison of superimposed high-frequency Jet Ventilation with conventional Jet Ventilation for laryngeal surgery
British journal of anaesthesia, 2012Co-Authors: R. Leiter, Andrea Aliverti, Rita Priori, P. Staun, A. Lo Mauro, Anders Larsson, Peter FrykholmAbstract:BackgroundNew 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 ventilat ...
Brad W. Desilva - One of the best experts on this subject based on the ideXlab platform.
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Airway Surgery Communication Protocol: A Quality Initiative for Safe Performance of Jet Ventilation.
The Laryngoscope, 2019Co-Authors: Laura Matrka, Brad W. Desilva, Liuba Soldatova, Daniel TraetowAbstract:OBJECTIVES To assess whether manual Jet Ventilation can safely be performed with variable anesthesia and operating room (OR) staff experience levels and communication skills. METHODS Jet Ventilation procedures for airway stenosis at a single institution over 35 months were retrospectively reviewed. OR and anesthesia staff were assigned scores based on experience level and communication skills. Data were analyzed for any association between the experience or communication skills of the staff and the successful use of Jet Ventilation, complication rate, or ultimate patient outcome, controlling for intraoperative variables and patient and airway complexity. A detailed preoperative surgeon-led communication protocol was followed in all cases. RESULTS Seventy procedures in 46 patients were performed. Jet Ventilation was successful in 69 of 70 cases. No relationship was found between staff experience or communication scores and the successful use of Jet Ventilation, complication rate, or ultimate patient outcome. The percentage of cases performed with a fully experienced team was low, at 7.1%. The experience level of the certified registered nurse anesthetist was significantly associated with likelihood of using an adequate paralytic dose upfront (P = 0.017), which in turn correlated with shorter anesthesia time by 19.7 minutes (P = 0.0131); however, neither affected complication rate nor ultimate patient outcome. The statements above remained true in cases of medically complex patients, difficult airways with high degrees of stenosis, and multiple shift changes. CONCLUSIONS Manual Jet Ventilation can be performed safely even in settings of lower staff experience level or communication skills given a surgeon experienced in the technique and a strict communication protocol. LEVEL OF EVIDENCE 4 Laryngoscope, 130:S1-S13, 2020.
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Airway Surgery Communication Protocol: A Quality Initiative for Safe Performance of Jet Ventilation.
The Laryngoscope, 2019Co-Authors: Laura Matrka, Brad W. Desilva, Liuba Soldatova, Daniel TraetowAbstract:To assess whether manual Jet Ventilation can safely be performed with variable anesthesia and operating room (OR) staff experience levels and communication skills. Jet Ventilation procedures for airway stenosis at a single institution over 35 months were retrospectively reviewed. OR and anesthesia staff were assigned scores based on experience level and communication skills. Data were analyzed for any association between the experience or communication skills of the staff and the successful use of Jet Ventilation, complication rate, or ultimate patient outcome, controlling for intraoperative variables and patient and airway complexity. A detailed preoperative surgeon-led communication protocol was followed in all cases. Seventy procedures in 46 patients were performed. Jet Ventilation was successful in 69 of 70 cases. No relationship was found between staff experience or communication scores and the successful use of Jet Ventilation, complication rate, or ultimate patient outcome. The percentage of cases performed with a fully experienced team was low, at 7.1%. The experience level of the certified registered nurse anesthetist was significantly associated with likelihood of using an adequate paralytic dose upfront (P = 0.017), which in turn correlated with shorter anesthesia time by 19.7 minutes (P = 0.0131); however, neither affected complication rate nor ultimate patient outcome. The statements above remained true in cases of medically complex patients, difficult airways with high degrees of stenosis, and multiple shift changes. Manual Jet Ventilation can be performed safely even in settings of lower staff experience level or communication skills given a surgeon experienced in the technique and a strict communication protocol. 4 Laryngoscope, 130:S1-S13, 2020. © 2019 The American Laryngological, Rhinological and Otological Society, Inc.
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Jet Ventilation in obese patients undergoing airway surgery for subglottic and tracheal stenosis
Laryngoscope, 2018Co-Authors: Ramez Philips, Brad W. Desilva, Laura MatrkaAbstract:OBJECTIVES/HYPOTHESIS To assess the feasibility of Jet Ventilation in obese patients and to compare complications of Jet Ventilation in obese and nonobese patients. STUDY DESIGN Retrospective review of medical records. METHODS We reviewed 46 patient charts (70 procedures) with the diagnosis of tracheal or subglottic stenosis who underwent endoscopic surgery with Jet Ventilation between March 2014 and January 2017. Adequacy of Jet Ventilation was assessed by chest rise, avoidance of endotracheal intubation, and length of case and Ventilation. Records were reviewed for demographic details, anesthesia records, and complications. RESULTS In 29/70 (41.4%) of cases, patients were obese; in 9/29 (31.0%) of these cases, patients were morbidly obese. Jet Ventilation was successful in 28/29 (97%) of obese cases. In 1/29 (3.4%) of cases, the patient required alternative airway management. There were no significant differences between obese and nonobese patients in chest rise, need for endotracheal intubation, and length of surgery or Ventilation (P > .05). There were 2/29 (6.9%) cases of intra- and postoperative complications including laryngospasm (1/29, 3.4%) and tachycardia (1/29, 3.4%). Rate of complications did not differ between obese and nonobese patients (P = .178). CONCLUSIONS Jet Ventilation in obese patients can be done successfully, and complications are similar between obese patients and nonobese patients. LEVEL OF EVIDENCE 4. Laryngoscope, 1887-1892, 2018.
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Jet Ventilation in obese patients undergoing airway surgery for subglottic and tracheal stenosis
The Laryngoscope, 2017Co-Authors: Ramez Philips, Brad W. Desilva, Laura MatrkaAbstract:To assess the feasibility of Jet Ventilation in obese patients and to compare complications of Jet Ventilation in obese and nonobese patients. Retrospective review of medical records. We reviewed 46 patient charts (70 procedures) with the diagnosis of tracheal or subglottic stenosis who underwent endoscopic surgery with Jet Ventilation between March 2014 and January 2017. Adequacy of Jet Ventilation was assessed by chest rise, avoidance of endotracheal intubation, and length of case and Ventilation. Records were reviewed for demographic details, anesthesia records, and complications. In 29/70 (41.4%) of cases, patients were obese; in 9/29 (31.0%) of these cases, patients were morbidly obese. Jet Ventilation was successful in 28/29 (97%) of obese cases. In 1/29 (3.4%) of cases, the patient required alternative airway management. There were no significant differences between obese and nonobese patients in chest rise, need for endotracheal intubation, and length of surgery or Ventilation (P > .05). There were 2/29 (6.9%) cases of intra- and postoperative complications including laryngospasm (1/29, 3.4%) and tachycardia (1/29, 3.4%). Rate of complications did not differ between obese and nonobese patients (P = .178). Jet Ventilation in obese patients can be done successfully, and complications are similar between obese patients and nonobese patients. 4. Laryngoscope, 1887-1892, 2018. © 2017 The American Laryngological, Rhinological and Otological Society, Inc.