Effects of Conventional and High Frequency Jet Ventilation on Lung Parenchyma

Keszler, Martin; Klein, Roy; McCLELLAN, Larry; Nelson, Donald S.; Platt, Melissa

doi:10.1097/00132586-198304000-00032

Cited by 8 publications

(10 citation statements)

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“…I9 Clinical reports describing resolution of preexisting severe pulmonary interstitial emphysema in newborns treated with HFJV suggest that these lower airway pressures may indeed be less damaging and allow resolution of existing baroinjury.20.21 Animal studies looking at the effects of HFJV on lung parenchyma have not been conclusive. In an earlier study, we demonstrated less hyperaeration (alveolar emphysema) compared to CV controls in the lungs of normal dogs ventilated by HFJV for up to 24 h. 16 By contrast, Quan et al, using saline lavaged rabbits, found no histologic difference between lungs exposed to CV and HFJV for 4 h. 22 An unintentional effect of lowering peak and mean airway pressures during high frequency ventilation is the development of progressive, diffuse atelectasis leading to a deterioration of oxygenation.899223 The addition of sigh breaths can counteract this phenomenon but may be associated with adverse effects unless carefully controlled. Ackerman et a1 reported on the findings of pulmonary interstitial emphysema and pseudocysts in immature baboons with hyaline membrane disease who were ventilated with a high frequency interruptor and intermittent manual sighs.…”

Section: Discussionmentioning

confidence: 61%

Lung pathology after high frequency jet ventilation combined with low rate intermittent mandatory ventilation in a canine model of meconium aspiration

Keszler

Reardon

1988

Pediatric Pulmonology

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The microscopic appearance of lungs subjected to six hours of conventional ventilation (CV), standard high frequency jet ventilation (HFJV), and HFJV combined with low rate intermittent mandatory ventilation (CHFJV) was studied in 22 mongrel puppies. A lung injury model was created by insufflating 4 ml/kg of a 20% mixture of meconium into the trachea. The animals were initially ventilated at the same mean airway pressure (Paw). Subsequently, if PCO2 fell below 20 torr, peak and mean airway pressures were reduced. A scoring system was devised which assigned 0-3 points for each of eight lung injury parameters, and a total lung injury score (TLIS) was calculated. CHFJV resulted in significantly less bronchopneumonia and edema, when compared to CV. A consistent, though not significant, trend toward lesser injury scores in CHFJV animals was noted for several other parameters. Six of eight lungs exposed to CV had TLIS greater than 5 compared to only 1 of 9 ventilated by CHFJV. (P = 0.02). It is concluded that CHFJV may have a protective effect on the lung, perhaps because effective gas exchange is achieved with a lower pressure amplitude and at lower Paw.

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Section: Discussionmentioning

confidence: 61%

Lung pathology after high frequency jet ventilation combined with low rate intermittent mandatory ventilation in a canine model of meconium aspiration

Keszler

Reardon

1988

Pediatric Pulmonology

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“…The effect of 24 hours of HFJV on lung parenchyma in anesthetized dogs is indistinguishable from that of PPV [9]. High-frequency jet ventilation also promotes alveolar recruitment of atelectactic lung [10], and is no different from optimized PPV in avoiding dynamic hyperinflation of end-stage chronic obstructive pulmonary disease patients [11].…”

Section: Discussionmentioning

confidence: 98%

Use of high-frequency jet ventilation for respiratory immobilization during coronary artery CT angiography

Mandel

Perry

Boonn

et al. 2009

Journal of Clinical Anesthesia

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“…Animal studies fail to show an increase in atelectasis or barotrauma with HFJV versus conventional ventilation (Keszler et al, 1982).…”

Section: Nursing Implications Respiratory Statusmentioning

confidence: 94%

“…The medical community has explored alternatives to conventional ventilation techniques in an attempt to provide adequate gas exchange while decreasing the incidence of iatrogenic lung disease (Carlo, Chatburn, & Martin, 1987;Keszler, Klein, McClellan, Nelson, & Platt, 1982;Polak & Neu, 1988;Special Conference Report, 1983). High-frequency ventilation has been under investigation since the 1960s as an alternative treatment modality (Spitzer, 1987).…”

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confidence: 99%