Influence of Tracheal Obstruction on the Efficacy of Superimposed High-frequency Jet Ventilation and Single-frequency Jet Ventilation

Sütterlin, R.; LoMauro, Antonella; Gandolfi, Stefano; Priori, Rita; Aliverti, Andréa; Frykholm, Peter; Larsson, Anders

doi:10.1097/aln.0000000000000818

Cited by 19 publications

(15 citation statements)

References 33 publications

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“…Features of stenosis that predicted longer cases included higher degree of obstruction, the presence of cartilage collapse, and a more inferior location of the stenosis. Similar findings have been reported in other studies . Specifically, authors have reported increased PaCO2 and decreased oxygenation with increased severity of stenosis, which in turn could underlie longer case length …”

Section: Discussionsupporting

confidence: 90%

Airway Surgery Communication Protocol: A Quality Initiative for Safe Performance of Jet Ventilation

et al. 2019

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Objectives: To assess whether manual jet ventilation can safely be performed with variable anesthesia and operating room (OR) staff experience levels and communication skills.Methods: Jet ventilation procedures for airway stenosis at a single institution over 35 months were retrospectively reviewed. OR and anesthesia staff were assigned scores based on experience level and communication skills. Data were analyzed for any association between the experience or communication skills of the staff and the successful use of jet ventilation, complication rate, or ultimate patient outcome, controlling for intraoperative variables and patient and airway complexity. A detailed preoperative surgeon-led communication protocol was followed in all cases.Results: Seventy procedures in 46 patients were performed. Jet ventilation was successful in 69 of 70 cases. No relationship was found between staff experience or communication scores and the successful use of jet ventilation, complication rate, or ultimate patient outcome. The percentage of cases performed with a fully experienced team was low, at 7.1%. The experience level of the certified registered nurse anesthetist was significantly associated with likelihood of using an adequate paralytic dose upfront (P = 0.017), which in turn correlated with shorter anesthesia time by 19.7 minutes (P = 0.0131); however, neither affected complication rate nor ultimate patient outcome. The statements above remained true in cases of medically complex patients, difficult airways with high degrees of stenosis, and multiple shift changes.Conclusions: Manual jet ventilation can be performed safely even in settings of lower staff experience level or communication skills given a surgeon experienced in the technique and a strict communication protocol.Key Words: Manual subglottic jet ventilation, operating room communication, anesthesia and surgeon cooperation, experience level in jet ventilation, endoscopic surgery for airway stenosis.

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Section: Discussionsupporting

confidence: 90%

Airway Surgery Communication Protocol: A Quality Initiative for Safe Performance of Jet Ventilation

et al. 2019

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“…Secondly, once a tracheal stenosis was added to this model, single-frequency HFJV at a frequency not exceeding 150 min −1 provided adequate CO 2 removal and oxygenation even in cases of severe airway obstruction (75% obstruction for the 4 mm stent) while for SHFJV, the frequency of the HFJV component of the SHFJV had little impact. In cases of severe stenosis, SHFJV improved gas exchange and lung volume which can be beneficial [16]. In clinical practice, tracheal stenosis is not the same as a fixed stent, so airflow due to SHFJV may produce shear and stress resulting in edema increasing the severity of the stenosis [5] and clinicians must be alert to this potential harmful event.…”

Section: Superimposed Jet Ventilationmentioning

confidence: 99%

“…As regards the settings, DP and/or I : E ratio of each jet component, little is known due to the complex interplay between the 2 components. Further studies are needed to gain understanding in this field [17]. …”

Section: Superimposed Jet Ventilationmentioning

confidence: 99%

Jet Ventilation during Rigid Bronchoscopy in Adults: A Focused Review

Putz

Mayné

Dincq

2016

BioMed Research International

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The indications for rigid bronchoscopy for interventional pulmonology have increased and include stent placements and transbronchial cryobiopsy procedures. The shared airway between anesthesiologist and pulmonologist and the open airway system, requiring specific ventilation techniques such as jet ventilation, need a good understanding of the procedure to reduce potentially harmful complications. Appropriate adjustment of the ventilator settings including pause pressure and peak inspiratory pressure reduces the risk of barotrauma. High frequency jet ventilation allows adequate oxygenation and carbon dioxide removal even in cases of tracheal stenosis up to frequencies of around 150 min−1; however, in an in vivo animal model, high frequency jet ventilation along with normal frequency jet ventilation (superimposed high frequency jet ventilation) has been shown to improve oxygenation by increasing lung volume and carbon dioxide removal by increasing tidal volume across a large spectrum of frequencies without increasing barotrauma. General anesthesia with a continuous, intravenous, short-acting agent is safe and effective during rigid bronchoscopy procedures.

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“…Nowadays, endoscopic treatment has been widely used as an effective method to treat CAO, palliating dyspnea in some cases of malignant obstruction and even be curative in some cases of benign tumor of in ammation [5][6][7] .Such procedures are mainly performed using rigid or exible bronchoscope.…”

Section: Introductionmentioning

confidence: 99%

“…These interventions are high-risky procedures, and posing a giant challenge to the anesthesiologists. How to establish adequate gas exchange to maintain the life of patients and allow good surgical access is what should be considered during anesthesia [6][7][8] .Furthermore, the choice of ventilation strategy and the use of skeletal muscle relaxants are still signi cant issues for anesthesiologists to consider.…”

Section: Introductionmentioning

confidence: 99%

Anesthesia Management in Patients With Central Airway Stenosis Undergoing Bronchoscopy Treatments - Safety Application of Muscle Relaxants and the Traditional Low-frequency Ventilation : A Retrospective Observational Study

et al. 2020

Preprint

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Background: Bronchoscopy treatments of central airway stenosis (CAO) under general anesthesia are high-risky procedures, and posing a giant challenge to the anesthesiologists. The aim of this research was to estimate the safety application of muscle relaxants and the traditional Low-frequency ventilation in patients with central airway stenosis undergoing bronchoscopy treatments under general anesthesia by summarizing our clinical experience.Methods: Clinical data of 375 patients with CAO who underwent urgent endoscopic treatments from January 2016 to October 2019 were retrospectively reviewed. The use ratio of skeletal muscle relaxants, dose of fentanyl and skeletal muscle relaxants used between rigid bronchoscopy compared with flexible bronchoscopy therapy, the incidence of perioperative adverse events, adequacy of ventilation and gas exchange, post-operative recovery and risk factors for postoperative ICU admission were evaluated. Results: There was a high usage rate (96.5%) of skeletal muscle relaxants in patients with CAO who underwent either flexible bronchoscopy or rigid bronchoscopy therapy and there is a higher dosage of analgesic and skeletal muscle relaxants used in rigid bronchoscopy compared with flexible bronchoscopy therapy. This procedure had a low incidence of perioperative adverse events, with no significant difference between flexible bronchoscopy and rigid bronchoscopy therapy. Sufficient ventilation was successfully established using the traditional Low-frequency ventilation both in flexible and rigid bronchoscopy group. There was a low mortality (0.8%) during the post-operative recovery, and the higher grade of ASA and obvious dyspnea or orthopnea were the independent risk factors for postoperative ICU admission. Conclusion: The use of proper dosage of muscle relaxants is indispensable and safe in patients with CAO undergoing bronchoscopy treatments and the traditional Low-frequency ventilation also can be used in this procedure safely.

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Influence of Tracheal Obstruction on the Efficacy of Superimposed High-frequency Jet Ventilation and Single-frequency Jet Ventilation

Abstract: In this in vivo porcine model of variable severe tracheal stenosis, SHFJV effectively increased lung volumes and maintained gas exchange and may be advantageous in severe airway obstruction.

Cited by 19 publications

References 33 publications

Airway Surgery Communication Protocol: A Quality Initiative for Safe Performance of Jet Ventilation

Airway Surgery Communication Protocol: A Quality Initiative for Safe Performance of Jet Ventilation

Jet Ventilation during Rigid Bronchoscopy in Adults: A Focused Review

Anesthesia Management in Patients With Central Airway Stenosis Undergoing Bronchoscopy Treatments - Safety Application of Muscle Relaxants and the Traditional Low-frequency Ventilation : A Retrospective Observational Study

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