High-frequency jet ventilation in European and North American institutions: developments and clinical practice

Abstract

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 ®stulae or pulmonary insuf®ciency. Despite a large body of published evidence describing its bene®ts 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 per-formed a search in a computerized database (MED-LINE) 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.

La sonde de ventilation en jet Hunsaker Mon-Jet est efficace dans les microchirurgies laryngées

“…3,4 There has been considerable debate regarding the combination of these ventilatory techniques and devices that provides the best operative visualization and access, utmost airway control, and optimal ventilation. 3,[5][6][7][8] In 1994, Hunsaker introduced a self-centering fluoroplastic laser-safe subglottic tube through which airway pressures and end-tidal CO 2 (ETCO 2 ) could be monitored. Driven by a dedicated automatic jet ventilator, this tube was specifically designed for use in laryngeal surgery and overcame many of the limitations of other devices.…”

The quality of the surgical field during functional endoscopic sinus surgery—The effect of the mode of ventilation—A randomized, prospective, double‐blind study

“…A major negative side-effect with this type of ventilation is the decreased blood drainage from the upper part of the body to the right heart, significant venous congestion and a potential for increased bleeding. This happens because of the high intra-thoracic pressures imposed by the IPPV and transmitted to the blood vessels with a consequent rise in the superior vena cava pressure and a reduced venous return to the heart (11)(12). The opposite happens, from the hemodynamic point of view, during normal spontaneous breathing and this may cause many surgeons to prefer local anesthesia for FESS.…”

Preliminary Validation of Transcutaneous CO<sub>2</sub> Monitoring in Patients Undergoing Cardiac Ablation Using Jet Ventilation

“…Use of jet ventilation requires frequent sampling of arterial blood gas in order to monitor arterial blood CO 2 level [7]. Based on the result of the intermittent ABG analysis, the anesthesiologist will make adjustments to the ventilator's settings.…”