Jet Venturi Ventilation Via  the Bullard Laryngoscope

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

“…Small-bore plastic or metal cannulae have been introduced by the nasotracheal, orotracheal or transtracheal route for supraglottic [6,37,39,40] or subglottic [2,3,5,41] application of jet streams, employing tubeless HFJV. To eliminate the need for tracheotomy, a jet device with coaxial bicannalicular design facilitating actively assisted expiration has been described for transtracheal jet ventilation of patients with upper airway obstruction [42].…”

“…The Bullard laryngoscope, a ®breoptic-aided laryngoscope with an anatomically-shaped rigid blade has been used to apply supralaryngeal jet ventilation via the side channel of the blade [6,39,40]. A special form of HFJV has been developed by combination of two jet streams with high and low frequency respectively, resulting in enlarged tidal volumes by the`double jet' technique (`superimposed HFJV') provided by a single jet respirator [37].…”

“…HFJV for thoracic and airway surgery. Advantages offered by HFJV for intraoperative ventilation of anaesthetized patients were reported as follows: (a) positioning of small-bore catheters or cannulae in the presence of airway stenoses with less effort than large tubes [2±5]; (b) performance of laser surgery with less risk, by avoiding the use of¯ammable plastic materials [6,39,45]; (c) improvement of surgical access and viewing of the larynx due to the smallbore tubes [2]; (d) simplifying access to a near motionless surgical ®eld and smoother process of surgery [22,52]; (e) reduced risk of aspiration of blood and debris due to continuous out¯ow of gases [52]; (e) optimizing oxygenation and venous return during thoracic surgery by HFJV to the dependent or nondependent lung [34,35,53±55] or to both [56]; (f) continuous ventilation during tracheal surgery during distal application of the jet stream [57]; (g) ventilation of patients' lungs following puncture of the cricothyroid membrane as a rescue measure (`can't intubate, can't ventilate' situation) [25±30]; (g) securing an airway with a jet catheter after tracheal extubation in patients at risk of respiratory distress and known dif®cult endotracheal intubation [58,59].…”

“…Anaesthetists involved with laryngotracheal surgical procedures were often confronted with con-siderable airway pathology resulting in stenoses and/ or restricted access to the patient's airway, small non-compliant catheters or cannulae were used to apply inspiratory gas by various routes [2±5]. Similarly, jet ventilation proved to be useful in the management of patients with dif®cult airways who were unable to sustain oxygenation during attempts at endotracheal intubation [6]. Secondly, respiratory support during pulmonary insuf®ciency seemed to be more favourable using smaller tidal pressure swings than during conventional mechanical ventilation (CV), in terms of preventing barotrauma and volutrauma.…”

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

“…Anaesthetists involved with laryngotracheal surgical procedures were often confronted with considerable airway pathology resulting in stenoses and/or restricted access to the patient's airway, small non‐compliant catheters or cannulae were used to apply inspiratory gas by various routes [2–5]. Similarly, jet ventilation proved to be useful in the management of patients with difficult airways who were unable to sustain oxygenation during attempts at endotracheal intubation [6]. Secondly, respiratory support during pulmonary insufficiency seemed to be more favourable using smaller tidal pressure swings than during conventional mechanical ventilation (CV), in terms of preventing barotrauma and volutrauma.…”