Clinical Experience with High Frequency Jet Ventilation

Carlon, Graziano C.; Kahn, Roberta C.; Howland, William S.; Ray, Cole; Turnbull, A. D.

doi:10.1097/00132586-198112000-00021

Cited by 14 publications

(23 citation statements)

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“…Concurrently high-frequency jet ventilation was proving lifesaving in adult and neonatal patients with life-threatening complications such as bronchopleural fistulas or severe pulmonary interstitial emphysema (8,9). Gentler ventilation in this setting meant using low peak and mean ventilator pressures as well as small tidal volumes.…”

Section: Evolution Of the "Open Lung" Conceptmentioning

confidence: 99%

“…Considering that healthy humans had well-aerated lungs, and airway closure and atelectasis appeared deleterious, we chose to give alveolar reexpansion top priority. Our goal was to use whatever mean pressures were necessary to achieve and maintain alveolar aeration recognizing that the small volume cycles generated at frequencies of 10 to 15 Hz provided the necessary margin of safety to avoid overdistension of more normal areas of lung.Concurrently high-frequency jet ventilation was proving lifesaving in adult and neonatal patients with life-threatening complications such as bronchopleural fistulas or severe pulmonary interstitial emphysema (8,9). Gentler ventilation in this setting meant using low peak and mean ventilator pressures as well as small tidal volumes.…”

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confidence: 99%

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High-frequency oscillatory ventilation: Lessons from the neonatal/pediatric experience

Froese¹,

Kinsella²

2005

Critical Care Medicine

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Efforts to minimize ventilator-induced lung injury in adults with hypoxemic respiratory failure have recently focused on the potential role of high-frequency oscillatory ventilation (HFOV). However, HFOV has been studied in newborns with hypoxemic respiratory failure for nearly 3 decades. In this brief review, we attempt to summarize key physiological principles learned from this cumulative neonatal/pediatric experience with HFOV.

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Section: Evolution Of the "Open Lung" Conceptmentioning

confidence: 99%

mentioning

confidence: 99%

High-frequency oscillatory ventilation: Lessons from the neonatal/pediatric experience

Froese¹,

Kinsella²

2005

Critical Care Medicine

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“…16 In adults, an extensive literature search revealed only 11 reported cases of VANTB. Nine of these patients were on HFJV and 2 were on CMV [15][16][17][18][19] (Table 1). Carlon et al described the first 2 reported adult cases of NTB as ''hemorrhagic tracheitis'' in 1981 in 2 patients on HFJV.…”

Section: Discussionmentioning

confidence: 99%

“…Both patients were severely thrombocytopenic (,20,000 platelets/mm 3 ) and found to have subtotal obstruction of the trachea and the 2 major bronchi on autopsy. 17 Delafosse et al described 6 more adult cases of NTB in patients undergoing a combination of CMV and HFJV for ARDS. 19 All patients were diagnosed by bronchoscopy and died shortly thereafter.…”

Section: Discussionmentioning

confidence: 99%

Ventilator-Associated Necrotizing Tracheobronchitis in a Patient on High-Frequency Oscillatory Ventilation

Bunt¹,

Chung²,

Omron³

et al. 2005

Journal of Bronchology

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High-frequency oscillatory ventilation (HFOV) is used extensively in the neonatal population. In adults, it is still considered an alternative mode of ventilation for cases of severe acute respiratory distress syndrome refractory to conventional mechanical ventilation (CMV). Reported complications with HFOV among adults include pneumothorax, pneumomediastinum, and subcutaneous emphysema. Ventilator-associated necrotizing tracheobronchitis (VANTB) is a well-documented complication with HFOV in neonates. In adults, only 11 cases have been reported, 9 patients on high-frequency jet ventilation, and 2 patients on CMV. We report a case of VANTB in an adult on HFOV, discuss potential causes, and offer management options. (J Bronchol 2005;12:96-99) H igh-frequency oscillatory ventilation (HFOV) is an alternate ventilator mode designed to optimize alveolar volume recruitment in patients with refractory hypoxemia. HFOV applies a constant mean airway pressure (mPaw) much like a conventional continuous positive airway pressure (CPAP) by using rapid cyclic pressure changes generated by an electromagnetic piston. This constant mPaw allows for an ''open lung'' while avoiding low end-expiratory pressures and high peak pressures. 1 Studies of HFOV in neonates demonstrate an improvement in oxygenation without an increased incidence of barotrauma or histopathologic evidence of ventilator-induced lung injury. 2 Recent findings have suggested that intervention early in the course of adult acute respiratory distress syndrome (ARDS) with HFOV may be beneficial. 1,3 Most observational studies have initiated HFOV in severe ARDS after the patient has been designated a conventional mechanical ventilation (CMV) failure. In a multicenter, randomized, controlled trial of HFOV in ARDS, Derdak demonstrated a greater improvement in oxygenation over CMV, although this difference was not sustained beyond 24 hours. 2 In a recent review, pneumothorax, pneumomediastinum, and subcutaneous emphysema are listed as potential complications associated with this mode. 3 To date, no cases of ventilator-associated necrotizing tracheobronchitis (VANTB) have been reported in association with HFOV. CASE REPORTA 41-year-old, previously healthy man presented with signs and symptoms of an acute abdomen and underwent appendectomy; the appendix was normal on pathologic examination. His immediate postoperative course was complicated by daily fevers. On the fifth hospital day, broad-spectrum antibiotics were initiated for progressively worsening hypoxemia and diffuse bilateral infiltrates on his chest radiograph. He was noted to have cervical and supraclavicular lymphadenopathy, and a computed tomography (CT) scan revealed diffuse interstitial infiltrates with mediastinal adenopathy. An excisional biopsy of the supraclavicular lymph nodes revealed anaplastic T cell lymphoma. On the eighth hospital day, he was transferred to the intensive-care unit (ICU) and intubated for hypoxemic respiratory failure with worsening pulmonary infiltrates. A chemotherapy regimen cons...

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“…It has also been reported useful in treating adult respiratory distress syndrome [18], bronchopleural fistulae [19], and air leak syndromes [18]. Much less is known about the use of HFJV in neonates.…”

Section: High Frequency Jet Ventilationmentioning

confidence: 99%

High-Frequency Ventilation in Newborn Infants

Boynton

Buckley

Frantz

1986

J Intensive Care Med

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In the past mechanical ventilation always mimicked the tidal volumes and ventilatory frequencies of normal breathing. Recently, there has been great interest in techniques that use rapid rates (60 to 3,000 per minute) and tidal volumes approximating dead space. These techniques are known collectively as high-frequency ventilation, although they differ in circuit design, use, potential complications, and mechanism of gas transport. High-frequency ventilation can be divided into four categories: (1) high-frequency positive pressure ventilation, (2) high-frequency jet ventilation, (3) highfrequency oscillatory ventilation and high-frequency flow interruption, and (4) high-frequency chest wall oscillation. In this review we discuss the similarities and differences of these high-frequency techniques, their clinical applications, and some physiological mechanisms involved in gas transport. High-Frequency Positive Pressure VentilationHigh-frequency positive pressure ventilation (HFPPV) was discovered by Sj6strand and coworkers [1] while searching for a method of mechanical ventilation that would not cause respiratory synchronous variations in blood pressure. Their original,system consisted of a small catheter placed in the lumen of an endotracheal tube through which compressed gas was delivered at frequencies of 60 to 100 per minute. This system proved impractical for clinical use, and a new ventilator was developed with low internal compliance and high driving pressure. Pulses of compressed gas entered the endotracheal tube through a side arm that functioned as a pneumatic valve [1] ] (Table).Standard mechanical ventilators have also been used for HFPPV [2]. The tidal volumes delivered during HFPPV vary among ventilators. Frantz [3], among others, has hypothesized that the tidal volume almost always exceeds dead space, whereas others [4,48] have reported tidal volumes as low as 3 ml/kg body weight. HFPPV is used frequently during bronchoscopy and tracheal surgery because it allows full airway access [5]. It has also been used to ventilate patients with adult respiratory distress syndrome because it helps mobilize secretions and decreases the need for sedation [6]. In the few studies on the use of HFPPV in neonates, HFPPV has been shown to maintain adequate gas exchange at low peak airway pressures [7]. Rates of 60 to 150 breaths per minute are often used in infants who are hypoxic or hypercapnic despite appropriate conventional ventilation. Rates of 120 to 150 per minute can be delivered by manual ventilation with an anesthesia bag or by conventional neonatal venat UNIVERSITE DE MONTREAL on June 14, 2015 jic.sagepub.com Downloaded from

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Clinical Experience with High Frequency Jet Ventilation

Cited by 14 publications

References 0 publications

High-frequency oscillatory ventilation: Lessons from the neonatal/pediatric experience

High-frequency oscillatory ventilation: Lessons from the neonatal/pediatric experience

Ventilator-Associated Necrotizing Tracheobronchitis in a Patient on High-Frequency Oscillatory Ventilation

High-Frequency Ventilation in Newborn Infants

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