A New and Safe Mode of Ventilation for Interventional Pulmonary Medicine: The Ease of Nasal Superimposed High Frequency Jet Ventilation

Abstract

We use pulmonary interventional procedures for the diagnosis of pulmonary diseases either for benign or malignant lesions. Flexible bronchoscopy with or without radial endobronchial ultrasound, convex-probe endobronchial ultrasound and electromagnetic navigation are procedures performed in centers with experience in diagnostic pulmonary medicine. The method of sedation and ventilation is very important in order to avoid or handle with success complications. Proper respiration during pulmonary (or other interventional) procedures is a key factor. Apart from the proper sedation method we have to choose the proper ventilation method which decides respiratory movement. Superimposed high-frequency jet ventilation (SHFJV) is supposed to be safe and effective in clinical practice. Although this perception is commonly accepted, there is no study proving its safety on the basic of reliable data. We analyzed the data of 100 patients in different interventional settings (bronchoscopy with or without navigational approach, left atrial appendage closure (LAAC) or intracardiac catheterization) using nasal SHFJV. Mainly analyzed were capillary ABG-Data at the beginning and end of the intervention under sedation. The aim was to analyze if a risk scenario for the patient by using the nasal SHFJV can be derived by measuring the changes of pCO2, pO2, cBase Excess, cHCO3 and PH. Due to our data we conclude that this method of ventilation can be easily and safely used in interventional medicine for patients with all kind of comorbidities such as; chronic respiratory disease, lung cancer, interstitial lung disease, structural heart disease and heart failure.

Lung cancer biopsies: Comparison between simple 22G, 22G upgraded and 21G needle for EBUS-TBNA

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High frequency jet ventilation through mask contribute to oxygen therapy in patients undergoing bronchoscopic intervention under deep sedation

“…Commonly used ventilation modes included COT, intermittent ventilation, controlled mechanical ventilation, and jet ventilation (manual or automatic, high or normal frequency) 11,12 . Ventilation mode is the most direct factor affecting oxygenation of patients, especially in MAC 6,13 . At present, common ventilation routes included nasal catheter, face mask, superior glottis airway tools, endotracheal tube, and tracheotomy tube.…”

“…HFJV became a technique to maintain ventilation since Klain and Smith developed it 5,6 . Gas enters the breathing path at low pressure through a narrow jet tube.…”

CFD Analysis of Flow Characteristics in a Jet Laryngoscope and the Different Application Forms of Superimposed Jet Ventilation

“…A new respiratory device (TwinStream, Carl Reiner, Vienna, Austria) has been developed for superimposed high-frequency jet ventilation (SHFJV) (Figure 12). Although the new technique is successfully used in clinical studies [27], there are few explanations about the structure and mechanism of the respirator. It is designed to allow both low-frequency and high-frequency jet ventilations simultaneously.…”