The Experts below are selected from a list of 222 Experts worldwide ranked by ideXlab platform
Gary R. Gutcher - One of the best experts on this subject based on the ideXlab platform.
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Safety and efficacy of high-frequency Jet ventilation in neonatal transport
Journal of Perinatology, 2007Co-Authors: E S Mainali, C Greene, H J Rozycki, Gary R. GutcherAbstract:Objective: To evaluate the safety and efficacy of high-frequency Jet ventilation for transporting critically ill hypoxic neonates to an extracorporeal membrane oxygenation (ECMO) center. Study Design: We conducted a retrospective cohort study of 38 transported neonates. Safety was assessed by the comparison of cardiopulmonary variables before and after transport from referring hospital to our ECMO unit. Efficacy was assessed as the effect on ventilation and efficiency of pulmonary gas exchange after conversion from a conventional mechanical Ventilator or a high-frequency oscillator to a high-frequency Jet Ventilator±inhaled nitric oxide. Result: The pre- and posttransport vital signs remained stable, regardless of the type of Ventilator used. Pre-transport pneumothorax was the main problem, but no transport-related deaths occurred. We found significant improvement in the ventilation of the neonates transported with a high frequency Jet ventilation±inhaled nitric oxide that were deficient in those transported with conventional mechanical ventilation+inhaled nitric oxide ( P
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Safety and efficacy of high-frequency Jet ventilation in neonatal transport
Journal of perinatology : official journal of the California Perinatal Association, 2007Co-Authors: E S Mainali, C Greene, H J Rozycki, Gary R. GutcherAbstract:To evaluate the safety and efficacy of high-frequency Jet ventilation for transporting critically ill hypoxic neonates to an extracorporeal membrane oxygenation (ECMO) center. We conducted a retrospective cohort study of 38 transported neonates. Safety was assessed by the comparison of cardiopulmonary variables before and after transport from referring hospital to our ECMO unit. Efficacy was assessed as the effect on ventilation and efficiency of pulmonary gas exchange after conversion from a conventional mechanical Ventilator or a high-frequency oscillator to a high-frequency Jet Ventilator±inhaled nitric oxide. The pre- and posttransport vital signs remained stable, regardless of the type of Ventilator used. Pre-transport pneumothorax was the main problem, but no transport-related deaths occurred. We found significant improvement in the ventilation of the neonates transported with a high frequency Jet ventilation±inhaled nitric oxide that were deficient in those transported with conventional mechanical ventilation+inhaled nitric oxide (P
Karen L. Posner - One of the best experts on this subject based on the ideXlab platform.
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The Hunsaker Mon-Jet tube with Jet ventilation is effective for microlaryngeal surgery
Canadian Journal of Anesthesia Journal canadien d'anesthésie, 2009Co-Authors: Joanna M. Davies, Allen D. Hillel, Nicole Maronian, Karen L. PosnerAbstract:Objectif Pour réaliser une microchirurgie laryngée, il faut atteindre un équilibre délicat entre le contrôle des voies aériennes et une visualisation adéquate de l’anatomie du larynx. Lors de l’introduction en 1994 de la sonde Hunsaker Mon-Jet (Xomed, Jacksonville, FL), un dispositif résistant au laser et à centrage automatique, destiné à procurer une ventilation sous-glottique, il semblait que les besoins de l’anesthésiologiste et du chirurgien étaient comblés. Toutefois, nous ne disposons que d’une quantité limitée de données concernant l’efficacité de ce dispositif dans une importante série de patients. L’objectif de cette étude de cohorte était d’explorer l’éventail de patients et d’interventions pour lesquels cette technique pouvait être utilisée. Méthode Nous rapportons une étude rétrospective portant sur 552 patients ayant subi une microchirurgie laryngée entre janvier 1995 et juin 2005 et pour lesquels la sonde Hunsaker Mon-Jet et un ventilateur par Jet automatique ont été utilisés pour la ventilation sous-glottique. Outre les données démographiques concernant les patients, le succès global de la ventilation et plusieurs devenirs périopératoires ont été évalués, notamment l’incidence de complications. Résultats Lorsqu’elle est utilisée conjointement avec un ventilateur par Jet automatique, la sonde Hunsaker Mon-Jet a été efficace chez plus de 98 % des 552 patients, y compris les patients présentant des co-morbidités graves, les patients obèses ou ceux présentant un accès difficile aux voies aériennes. La sonde a procuré une visualisation optimale des cordes vocales ainsi qu’un excellent accès chirurgical dans un large éventail de troubles laryngés, notamment dans les traitements au laser. Chez moins de 2 % des patients, une hypoxie, une hypercapnie, ou l’apparition de ces deux complications, ont nécessité d’échanger la sonde Hunsaker Mon-Jet contre une sonde endotrachéale standard ou résistante au laser, ce qui a permis une résolution rapide des complications. Conclusion La ventilation sous-glottique avec la sonde Hunsaker Mon-Jet combinée à un ventilateur par Jet automatique peut être considérée comme une technique efficace, sécuritaire et polyvalente pour la prise en charge anesthésique de la microchirurgie laryngée. Purpose Microlaryngeal surgery involves a delicate balance between airway control and appropriate visualization of laryngeal anatomy. When the self-centering, laser-safe Hunsaker Mon-Jet tube (Xomed, Jacksonville, FL) was introduced in 1994, to provide subglottic ventilation, the needs of both anesthesiologist and surgeon appeared to have been adequately met. However, limited data exists regarding the efficacy of this device in a large patient series. The aim of this cohort study was to explore the spectrum of patients and procedures for which this technique could be used. Methods We report a retrospective study of 552 patients who had undergone microlaryngeal surgery between January 1995 and June 2005, utilizing the Hunsaker Mon-Jet tube and automated Jet Ventilator to provide subglottic ventilation. In addition to patient demographics, overall success of ventilation and several perioperative outcomes were evaluated, including the incidence of complications. Results In combination with an automatic Jet Ventilator, the Hunsaker Mon-Jet tube was successfully utilized in more than 98% of the 552 patients, including those with severe co-morbidities, obesity and difficult airway access, providing optimal visualization of the vocal cords and excellent surgical access for a wide range of laryngeal disorders, including laser treatment. In less than 2% of patients, hypoxia, hypercarbia, or both, necessitated exchange of the Hunsaker Mon-Jet tube for a standard or laser-safe endotracheal tube with rapid resolution of the precipitating cause. Conclusions Subglottic ventilation via the Hunsaker Mon-Jet tube with an automated Jet Ventilator may be considered an effective, safe and versatile technique for the anesthetic management of microlaryngeal surgery.
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The Hunsaker Mon-Jet tube with Jet ventilation is effective for microlaryngeal surgery
Canadian journal of anaesthesia = Journal canadien d'anesthesie, 2009Co-Authors: Joanna M. Davies, Allen D. Hillel, Nicole Maronian, Karen L. PosnerAbstract:Purpose Microlaryngeal surgery involves a delicate balance between airway control and appropriate visualization of laryngeal anatomy. When the self-centering, laser-safe Hunsaker Mon-Jet tube (Xomed, Jacksonville, FL) was introduced in 1994, to provide subglottic ventilation, the needs of both anesthesiologist and surgeon appeared to have been adequately met. However, limited data exists regarding the efficacy of this device in a large patient series. The aim of this cohort study was to explore the spectrum of patients and procedures for which this technique could be used. Methods We report a retrospective study of 552 patients who had undergone microlaryngeal surgery between January 1995 and June 2005, utilizing the Hunsaker Mon-Jet tube and automated Jet Ventilator to provide subglottic ventilation. In addition to patient demographics, overall success of ventilation and several perioperative outcomes were evaluated, including the incidence of complications. Results In combination with an automatic Jet Ventilator, the Hunsaker Mon-Jet tube was successfully utilized in more than 98% of the 552 patients, including those with severe co-morbidities, obesity and difficult airway access, providing optimal visualization of the vocal cords and excellent surgical access for a wide range of laryngeal disorders, including laser treatment. In less than 2% of patients, hypoxia, hypercarbia, or both, necessitated exchange of the Hunsaker Mon-Jet tube for a standard or laser-safe endotracheal tube with rapid resolution of the precipitating cause. Conclusions Subglottic ventilation via the Hunsaker Mon-Jet tube with an automated Jet Ventilator may be considered an effective, safe and versatile technique for the anesthetic management of microlaryngeal surgery.
Deok Won Kim - One of the best experts on this subject based on the ideXlab platform.
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Development of Fine Time Controller of a Transtracheal Jet Ventilator and Its Experimental Application
Korean Journal of Anesthesiology, 2002Co-Authors: Hae Keum Kil, Wyun Kon Park, Jang Ho Roh, Jae Kwang Shim, Hoon Kim, Joo Hyun Ahn, Deok Won KimAbstract:Background: Transtracheal Jet ventilation (TTJV) with a large-bore angiocath that is inserted through the cricothyroid membrane can provide immediate oxygenation from a high pressure-oxygen wall outlet, as well as ventilation by means of manual triggering. However, there is widespread agreement that TTJV with a high pressure oxygen system may induce numerous complications including tracheal hemorrhage/ulceration, subcutaneous/mediastinal emphysema, and barotrauma resulting in a pneumothorax. The goal of this study was to highlight the potential effectiveness of a TTJ-Ventilator with an oxygen supply pressure lower than 50 psig for proper oxygenation and ventilaton avoiding the possibility of complications from a high pressure oxygen supply system. Methods: Five mongrel dogs were intubated, paralyzed with vecuronium,and mechanically ventilated with enflurane in air maintaining the at 35-40 mmHg. A 16 G IV catheter was inserted percutaneously into the trachea below the tip of the endotrachealtube. We measured the injection volumes, entrained air volumes, and peak inflation pressures according d the changes of oxygen supply pressure (10 to 50 psig) with a fixed injection time (1 second). In addition, we evaluated the oxygenation effects of TTJV at 15 breaths per minute and an I: E 1 : 3 on 20 psig of oxygen supply pressure in hypoxic dogs. Results: A 16 G angiocath provided the injected volumes from 139 ml to 595 ml according to the changes of oxygen pressure from 10 to 50 psig. The entrained if volumes were 6.7-48% of total inspirated volumes. The was elevated over 300 mmHg and the was reduced to 45 mmHg within 1 minute of TTJV in hypoxic dogs. Conclusions: A TTJV system equipped with a time-controller and pressure-regulator can provide enough tidal volume to maintain oxygenation, and could minimize the volu/barotrauma of a conventional TTJV.
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The Development of an Inspiratory Time Adjustable Transtracheal Jet Ventilator and Evaluation in a Human Adult Trachea-Lung Model
Korean Journal of Anesthesiology, 2001Co-Authors: Hoon Kim, Hae Keum Kil, Wyun Kon Park, Joo Hyun Ahn, Deok Won KimAbstract:Background: Transtracheal Jet ventilation (TTJV) has been used for ‘Cannot Ventilate/Cannot Intubate’ situation, lefe-saving situations, by simply introducing an IV catheter (angiocatheter) through the cricothyroid membrane. To decrease the occurrence of barotrauma caused by a continuous high pressure oxygen supply while applying TTJV, it would be ideal to have a TTJV system equipped with an inspiration time adjustable function which any currently commercially available TTJV does not have. Methods: Recently, we made a prototype of an inspiration time adjustable TTJV and measured the corresponding injection volumes and peak inflation pressures according to the changes of oxygen supply pressure and inspiration time using catheters ranging from 14 to 20 G in a simulated human adult trachea-lung model. Results: A 16 G angiocatheter provided 465 ± 5 ml of injected volume with a peak inflation pressure of 25 cmH2O under a 50 psi oxygen supply at 1 second of inspiration, which would be adequate for an adult tidal volume. When a 14 G catheter was used under the same conditions as above, the injected volume was 1128 ± 9 ml. All injected volumes were under 310 ml when 18 and 20 G angiocathers were used at various driving pressures (10-50 psi) and inspiration time (0.5, 0.75, and 1 s). Conclusions: An inspiration time adjustable TTJV can easily provide enough tidal volume to maintain oxygenation, and could be expected to prevent or reduce barotraumatic complications such as pneumothorax. (Korean J Anesthesiol 2001; 40: 211∼219) ꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏ
E S Mainali - One of the best experts on this subject based on the ideXlab platform.
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Safety and efficacy of high-frequency Jet ventilation in neonatal transport
Journal of Perinatology, 2007Co-Authors: E S Mainali, C Greene, H J Rozycki, Gary R. GutcherAbstract:Objective: To evaluate the safety and efficacy of high-frequency Jet ventilation for transporting critically ill hypoxic neonates to an extracorporeal membrane oxygenation (ECMO) center. Study Design: We conducted a retrospective cohort study of 38 transported neonates. Safety was assessed by the comparison of cardiopulmonary variables before and after transport from referring hospital to our ECMO unit. Efficacy was assessed as the effect on ventilation and efficiency of pulmonary gas exchange after conversion from a conventional mechanical Ventilator or a high-frequency oscillator to a high-frequency Jet Ventilator±inhaled nitric oxide. Result: The pre- and posttransport vital signs remained stable, regardless of the type of Ventilator used. Pre-transport pneumothorax was the main problem, but no transport-related deaths occurred. We found significant improvement in the ventilation of the neonates transported with a high frequency Jet ventilation±inhaled nitric oxide that were deficient in those transported with conventional mechanical ventilation+inhaled nitric oxide ( P
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Safety and efficacy of high-frequency Jet ventilation in neonatal transport
Journal of perinatology : official journal of the California Perinatal Association, 2007Co-Authors: E S Mainali, C Greene, H J Rozycki, Gary R. GutcherAbstract:To evaluate the safety and efficacy of high-frequency Jet ventilation for transporting critically ill hypoxic neonates to an extracorporeal membrane oxygenation (ECMO) center. We conducted a retrospective cohort study of 38 transported neonates. Safety was assessed by the comparison of cardiopulmonary variables before and after transport from referring hospital to our ECMO unit. Efficacy was assessed as the effect on ventilation and efficiency of pulmonary gas exchange after conversion from a conventional mechanical Ventilator or a high-frequency oscillator to a high-frequency Jet Ventilator±inhaled nitric oxide. The pre- and posttransport vital signs remained stable, regardless of the type of Ventilator used. Pre-transport pneumothorax was the main problem, but no transport-related deaths occurred. We found significant improvement in the ventilation of the neonates transported with a high frequency Jet ventilation±inhaled nitric oxide that were deficient in those transported with conventional mechanical ventilation+inhaled nitric oxide (P
Alexander Aloy - One of the best experts on this subject based on the ideXlab platform.
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humidification
2013Co-Authors: Paul Kraincuk, Anton Kepka, Gerald Ihra, Christa Schabernig, Alexander Aloy, Correspondence Alex, Er AloyAbstract:new prototype of an electronic Jet-Ventilator and it
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A new prototype of an electronic Jet-Ventilator and its humidification system
Critical Care, 1999Co-Authors: Paul Kraincuk, Anton Kepka, Gerald Ihra, Christa Schabernig, Alexander AloyAbstract:Background Adequate humidification in long-term Jet ventilation is a criticalaspect in terms of clinical safety. Aim To assess a prototype of an electronic Jet-Ventilator and itshumidification system. Methods Forty patients with respiratory insufficiency were randomlyallocated to one of four groups. The criterion for inclusion in this study wasrespiratory insufficiency exhibiting a Murray score above 2. The four groups ofpatients were ventilated with three different respirators and four differenthumidification systems. Patients in groups A and B received superimposedhigh-frequency Jet ventilation (SHFJV) by an electronic Jet-Ventilator eitherwith (group A) or without (group B) an additional humidification system. Patients in group C received high-frequency percussive ventilation (HFPV) by apneumatic high-frequency respirator, using a hot water humidifier for warmingand moistening the inspiration gas. Patients in group D received conventionalmechanical ventilation using a standard intensive care unit respirator with astandard humidification system. SHFJV and HFPV were used for a period of 100 h(4days). Results A significantly low inspiration gas temperature was noted inpatients in group B, initially (27.2 ± 2.5°C) and after 2 days(28.0 ± 1.6°C) ( P < 0.05). The percentage of relativehumidity of the inspiration gas in patients in group B was also initiallysignificantly low (69.8 ± 4.1%; P < 0.05) but rose to an averageof 98 ± 2.8% after 2 h. The average percentage across all four groupsamounted to 98 ± 0.4% after 2 h. Inflammation of the tracheal mucosa wasfound in patients in group B and the (MIS) wassignificantly higher than in all the other groups. Patients in groups A, C andD showed no severe evidence of airway damage, exhibiting adequate values ofrelative humidity and temperature of the inspired gas. Conclusion The problems of humidification associated with Jet ventilation canbe fully prevented by using this new Jet-Ventilator. These data were sustainedby nondeteriorating MIS values at the end of the 4-day study period in groupsA, C and D.
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A new prototype of an electronic Jet-Ventilator and its humidification system
Critical care (London England), 1999Co-Authors: Paul Kraincuk, Anton Kepka, Gerald Ihra, Christa Schabernig, Alexander AloyAbstract:Background Adequate humidification in long-term Jet ventilation is a criticalaspect in terms of clinical safety.