High‐frequency Positive‐pressure Ventilation by Endotracheal Insufflation

Jonzon, Anders; Öberg, Peter; Sedin, Gunnar; Sjöstrand, Ulf

doi:10.1111/j.1399-6576.1971.tb05463.x

Cited by 64 publications

(16 citation statements)

References 30 publications

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“…In 1971, Jonzon et al [5] introduced the technique of high frequency positive pressure ventilation which has been refined and used extensively in anaesthesia. The main concern with high frequency jet ventilation is that it causes a rapid build-up of pressure if there is inadequate egress of air during expiration [6].…”

Section: ó 2008 the Authorsmentioning

confidence: 99%

High frequency jet ventilation through the laryngeal mask airway in a critically obstructed airway

2008

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A 72 year-old man with an anticipated difficult airway secondary to a large, obstructing supraglottic tumour was scheduled for a panendoscopy. An elective pre-induction transtracheal catheter was placed to allow oxygenation if airway maintenance proved difficult. Following induction of anaesthesia, tracheal intubation was impossible and ventilation via both a facepiece and a laryngeal mask airway became progressively more difficult. An emergency tracheostomy was attempted whilst oxygenation was maintained with transtracheal jet ventilation, but the position of the transtracheal catheter made tracheostomy impossible. The catheter was removed and high frequency jet ventilation was then used via the laryngeal mask airway to maintain oxygenation. To our knowledge, the use of high frequency jet ventilation through the laryngeal mask airway in a critically obstructed airway has not been described before. A difficult airway is defined as the clinical situation in which a conventionally trained anaesthesist experiences difficulty with ventilation of the lungs by facepiece, difficulty with tracheal intubation, or both [1]. We describe such a case where high frequency jet ventilation through a laryngeal mask airway was used to maintain oxygenation over a critical period. Case historyA 72 year-old man was admitted to our hospital with severe stridor and respiratory distress of 3 days' duration and dysphagia for two weeks. He was an ex-smoker with a past history of myocardial infarction and angioplasty and was being treated for hypertension, hypercholesterolaemia and chronic obstructive pulmonary disease (COPD). One year previously, he had been investigated at his local hospital for a hoarse voice and diagnosed with an idiopathic left vocal cord paralysis. One month previously he had been admitted to the same hospital and diagnosed with an infective exacerbation of COPD that improved with steroids and antibiotics. In our hospital, he was stabilised with intravenous steroids and antibiotics, adrenaline nebulisers and bronchodilators. Surgical nasal endoscopy revealed a left paramedian vocal cord appearance in keeping with his idiopathic palsy. On the right, a mass replacing the false cord and prolapsing across the midline was seen with significant airway occlusion. The right hemilarynx was noted to be fixed and there was pooling of secretions in the right pyriform fossa. A panendoscopy and biopsy were scheduled for tissue diagnosis.In our unit our preferred technique for such cases is to maintain oxygenation with a pre-induction transtracheal catheter and then secure the airway once the patient is anaesthetised. Therefore, a 13-G Ravussin jet ventilation catheter (VBM Medizintechnik GmbH, Sulz, Germany) was inserted between the first and second tracheal rings under local anaesthesia and placement confirmed by a regular capnograph trace. Anaesthesia was induced with 100 lg fentanyl and 200 mg propofol. The patient was given 30 mg atracurium and anaesthesia was maintained with sevoflurane in oxygen. Initially, the lungs were e...

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Section: ó 2008 the Authorsmentioning

confidence: 99%

High frequency jet ventilation through the laryngeal mask airway in a critically obstructed airway

2008

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“…The first description of high-frequency ventilation in a clinical setting is attributed to either Lunkenheimer et al in 1972 32 or Jonzon et al in 1971, 33 both of whom used the technique to minimise the cyclical effects of intermittent positive-pressure ventilation on the cardiovascular system. Subsequent research into high-frequency ventilation initially concentrated on three techniques to deliver the breaths, HFOV, high-frequency positive-pressure ventilation (HFPPV) and high-frequency jet ventilation (HFJV).…”

Section: History Of Artificial Ventilationmentioning

confidence: 99%

A randomised controlled trial and cost-effectiveness analysis of high-frequency oscillatory ventilation against conventional artificial ventilation for adults with acute respiratory distress syndrome. The OSCAR (OSCillation in ARDS) study

Lall

Hamilton

Young

et al. 2015

Health Technology Assessment

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BackgroundPatients with the acute respiratory distress syndrome (ARDS) require artificial ventilation but this treatment may produce secondary lung damage. High-frequency oscillatory ventilation (HFOV) may reduce this damage.ObjectivesTo determine the clinical benefit and cost-effectiveness of HFOV in patients with ARDS compared with standard mechanical ventilation.DesignA parallel, randomised, unblinded clinical trial.SettingUK intensive care units.ParticipantsMechanically ventilated patients with a partial pressure of oxygen in arterial blood/fractional concentration of inspired oxygen (P : F) ratio of 26.7 kPa (200 mmHg) or less and an expected duration of ventilation of at least 2 days at recruitment.InterventionsTreatment arm HFOV using a Novalung R100®ventilator (Metran Co. Ltd, Saitama, Japan) ventilator until the start of weaning.Control arm Conventional mechanical ventilation using the devices available in the participating centres.Main outcome measuresThe primary clinical outcome was all-cause mortality at 30 days after randomisation. The primary health economic outcome was the cost per quality-adjusted life-year (QALY) gained.ResultsOne hundred and sixty-six of 398 patients (41.7%) randomised to the HFOV group and 163 of 397 patients (41.1%) randomised to the conventional mechanical ventilation group died within 30 days of randomisation (p = 0.85), for an absolute difference of 0.6% [95% confidence interval (CI) −6.1% to 7.5%]. After adjustment for study centre, sex, Acute Physiology and Chronic Health Evaluation II score, and the initial P : F ratio, the odds ratio for survival in the conventional ventilation group was 1.03 (95% CI 0.75 to 1.40;p = 0.87 logistic regression). Survival analysis showed no difference in the probability of survival up to 12 months after randomisation. The average QALY at 1 year in the HFOV group was 0.302 compared to 0.246. This gives an incremental cost-effectiveness ratio (ICER) for the cost to society per QALY of £88,790 and an ICER for the cost to the NHS per QALY of £78,260.ConclusionsThe use of HFOV had no effect on 30-day mortality in adult patients undergoing mechanical ventilation for ARDS and no economic advantage. We suggest that further research into avoiding ventilator-induced lung injury should concentrate on ventilatory strategies other than HFOV.Trial registrationCurrent Controlled Trials ISRCTN10416500.FundingThis project was funded by the NIHR Health Technology Assessment programme and will be published in full inHealth Technology Assessment; Vol. 19, No. 23. See the NIHR Journals Library website for further project information.

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“…As frequency was increased, it was necessary to increase minute volume to compensate for the increased VD/VT ratio, but at frequencies above 1.67 Hz the available minute volume (about 30 1 min-') was not sufficient to maintain normal blood gas tensions. At frequencies above 1 High frequency jet ventilation A great deal of clinical experience has now been accumulated with HFJV, based on either fluid logic or electronically controlled ventilators. With the latter inspiration is produced by the opening of a solenoid operated valve connected to a high pressure gas source (usually 200-400 kPa (2-4 atmospheres)).…”

Section: High Frequency Positive Pressure Ventilationmentioning

confidence: 99%

“…The technique was first used experimentally in the late 1960s' to minimise fluctuations in intraarterial pressure associated with mechanical ventilation and has now been used for respiratory support in patients with normal and abnormal lungs. The range of frequencies used is 1-40 Hz (60-2400 bpm), the lower range (1)(2)(3)(4)(5) being used predominantly with high frequency positive pressure ventilation (HFPPV), or high frequency jet ventilation (HFJV), and the higher range (5-40 Hz) with high frequency oscillation (HFO). Although this rather crude categorisation ignores many of the subtle differences in the design of the ventilator and gas delivery systems which may affect their performance, it highlights the essential differences between the three techniques.…”

Section: High Frequency Ventilationmentioning

confidence: 99%

“…With the latter inspiration is produced by the opening of a solenoid operated valve connected to a high pressure gas source (usually 200-400 kPa (2-4 atmospheres)). The opening time of the valve may be adjusted from 40 to 500 msec, thus providing a Ti/ Ttot of 20-50% at frequencies of [1][2][3][4][5] Hz. The driving gas is delivered to the patient through a jet (usually 1.0-1.8 mm in internal diameter), the inspiratory flow rate being determined by the driving pressure, the resistance of the solenoid valve and connecting tubing, and the resistance of the jet.…”

Section: High Frequency Positive Pressure Ventilationmentioning

confidence: 99%

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High frequency ventilation.

Sykes¹

1985

Thorax

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High‐frequency Positive‐pressure Ventilation by Endotracheal Insufflation

Abstract: ISBN 87 504 0276 5 PAINTED IN DENMARK BY AARHUUS STIFTSBOGTRYKXERIE A115

Cited by 64 publications

References 30 publications

High frequency jet ventilation through the laryngeal mask airway in a critically obstructed airway

High frequency jet ventilation through the laryngeal mask airway in a critically obstructed airway

A randomised controlled trial and cost-effectiveness analysis of high-frequency oscillatory ventilation against conventional artificial ventilation for adults with acute respiratory distress syndrome. The OSCAR (OSCillation in ARDS) study

High frequency ventilation.

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