External Jet Nebulization and Measured Ventilator Performance.

BACKGROUND: During invasive ventilation, external flow jet nebulization results in increases in displayed exhaled tidal volumes (VT). We hypothesized that the magnitude of the increase is inaccurate. An ASL 5000 simulator measured ventilatory parameters over a wide range of adult settings: actual VT, peak inspiratory pressure (PIP), and time to minimum pressure. METHODS: Ventilators with internal and external flow sensors were tested by using a variety of volume and pressure control modes (the target VT was 420 mL). Patient conditions (normal, COPD, ARDS) defined on the ASL 5000 were assessed at baseline and with 3.5 or 8 L/min of added external flow. Patient-triggering was assessed by reducing muscle effort to the level that resulted in backup ventilation and by changing ventilator sensitivity to the point of auto-triggering. RESULTS: Results are reported as percentage change from baseline after addition of 3.5 or 8 L/min external flow. For ventilators with internal flow sensors, changes in displayed exhaled VT ranged from 10% to 118%, however, when using volume control, actual increases in actual VT and PIP were only 4%-21% (P = .063, .031) and 6%-24% (P = .25, .031), respectively. Changes in actual VT correlated closely with changes in PIP (P < .001; R2 = 0.68). For pressure control, actual VT decreased by 3%-5% (P = .031) and 4%-9% (P = .031) with 3.5 and 8 L/min respectively, PIP was unchanged. With external flow sensors at the distal Y-piece junction, volume and pressure changes were statistically insignificant. The time to minimum pressure increased at most by 8% (P = .02) across all modes and ventilators. The effects on muscle pressure were minimal (∼1 cm H2O), and ventilator sensitivity effects were nearly undetectable. CONCLUSIONS: External flow jet nebulization resulted in much smaller changes in volume than indicated by the ventilator display. Statistically significant effects were confined primarily to machines with internal flow sensors. Differences approached the manufacturer-reported variation in ventilator baseline performance. During nebulizer therapy, effects on VT can be estimated at the bedside by monitoring PIP.

High-Frequency Jet Ventilation Versus Spontaneous Respiration for Percutaneous Cryoablation of Lung Tumors: Comparison of Adverse Events and Procedural Efficiency.

BACKGROUND. High-frequency jet ventilation (HFJV) facilitates accurate probe placement in percutaneous ablation of lung tumors but may increase risk for adverse events, including systemic air embolism. OBJECTIVE. The purpose of this study was to compare major adverse events and procedural efficiency of percutaneous lung ablation with HFJV under general anesthesia to spontaneous respiration (SR) under moderate sedation. METHODS. This retrospective study included consecutive adults who underwent CT-guided percutaneous cryoablation of one or more lung tumors with HFJV or SR between January 1, 2017, and May 31, 2023. We compared major adverse events (Common Terminology Criteria for Adverse Events grade ≥ 3) within 30 days postprocedure and hospital length of stay (HLOS) of 2 days or more using logistic regression analysis. We compared procedure time, room time, CT guidance acquisition time, CT guidance radiation dose, total radiation dose, and pneumothorax using generalized estimating equations. RESULTS. Overall, 139 patients (85 women, 54 men; median age, 68 years) with 310 lung tumors (82% metastases) underwent 208 cryoablations (HFJV, n = 129; SR, n = 79). HFJV showed greater rates than SR for the treatment of multiple tumors per session (43% vs 19%, respectively; p = .02) and tumors in a nonperipheral location (48% vs 24%, p < .001). Major adverse event rate was 8% for HFJV and 5% for SR (p = .46). No systemic air embolism occurred. HLOS was 2 days or more in 17% of sessions and did not differ significantly between HFJV and SR (p = .64), including after adjusting for probe number per session, chronic obstructive pulmonary disease, and operator experience (p = .53). Ventilation modalities showed no significant difference in procedure time, CT guidance acquisition time, CT guidance radiation dose, or total radiation dose (all p > .05). Room time was longer for HFJV than SR (median, 154 vs 127 minutes, p < .001). For HFJV, the median anesthesia time was 136 minutes. Ventilation modalities did not differ in the frequencies of pneumothorax or pneumothorax requiring chest tube placement (both p > .05). CONCLUSION. HFJV appears to be as safe as SR but had longer room times. HFJV can be used in complex cases without significantly impacting HLOS of 2 days or more, procedure time, or radiation exposure. CLINICAL IMPACT. Selection of the ventilation modality during percutaneous lung ablation should be based on patient characteristics and anticipated procedural requirements as well as operator preference.

High frequency jet ventilator ‒ a new approach in the management of anesthesia for pediatric cardiac Magnetic Resonance Imaging: case series / Ventilação a jato de alta frequência - uma nova abordagem no manejo da anestesia para ressonância magnética em cardiologia pediátrica: série de casos

Abstract Background and objectives: Cardiac Magnetic Resonance Imaging (MRI) is a technique used for evaluation of children with congenital heart diseases. General anesthesia ensures immobility, particularly in uncooperative patients. However, chest wall movements can limit good quality scans. Prolonged apnea may be necessary to decrease respiratory motion artefacts, potentially leading to hypoxemia and other adverse events. The use of a high frequency jet ventilator may be a solution avoiding chest wall movements. Case report: We report four cases of pediatric patients, ASA II, aged between 4 and 15 years-old, scheduled for cardiac MRI. General anesthesia was proposed and parental informed consent was obtained. After general anesthesia was induced, an uncuffed endotracheal tube was inserted. Then, a 7Fr × 40 cm catheter was placed through the endotracheal tube. The proximal outlet of the catheter was attached through a connecting tube to a high frequency jet ventilator (Monsoon III®, Acutronic Medical Systems). Good quality MRI images were obtained. At the end of the procedures, we observed increased salivation and increased end-tidal CO2 (60-70 mmHg), in all patients. The patients were extubated after normocapnia was achieved and neuromuscular blockade reversed. Following appropriate recovery time, the four children were discharged home the same day. Conclusions: This case series demonstrates that the use of a high frequency jet ventilator for cardiac MRI was feasible, safe, providing good quality cardiac imaging and avoiding anesthesia personnel to be inside the hazardous environment of MRI room. Future studies are needed to confirm its safety and efficiency in pediatric patients.

Resumo Justificativa e objetivos: A ressonância magnética (RM) cardíaca é uma técnica usada na avaliação de crianças com cardiopatias congênitas. A anestesia geral garante imobilidade, especialmente em pacientes não cooperadores, porém os movimentos da parede torácica podem limitar a boa qualidade dos exames. A apneia prolongada pode ser necessária para diminuir os artefatos do movimento respiratório, potencialmente levando à hipoxemia e outros eventos adversos. O uso de ventilação a jato de alta frequência pode ser uma solução para evitar os movimentos da parede torácica. Relato de caso: Relatamos quatro casos de pacientes pediátricos, ASA II, entre 4-15 anos, programados para ressonância magnética cardíaca. Uma anestesia geral foi proposta e assinaturas em termo de consentimento livre e esclarecido foram obtidas dos pais. Após a indução da anestesia geral, um tubo endotraqueal sem balonete foi inserido. Em seguida, um cateter de 7Fr × 40 cm foi inserido através do tubo endotraqueal. A saída proximal do cateter foi conectada, mediante um tubo conector, a um sistema de ventilação a jato de alta frequência (Monsoon III®, Acutronic Medical Systems). Imagens de ressonância magnética de boa qualidade foram obtidas. No fim dos procedimentos, observamos aumento tanto de salivação quanto de CO2 expirado (60-70 mmHg) em todos os pacientes. Os pacientes foram extubados após a obtenção de normocapnia e reversão do bloqueio neuromuscular. Após o tempo de recuperação apropriado, as quatro crianças receberam alta no mesmo dia. Conclusões: Esta série de casos demonstra que o uso de um sistema de ventilação a jato de alta frequência para ressonância magnética cardíaca é viável e seguro, além de fornecer imagens cardíacas de boa qualidade e evitar a presença da equipe de anestesia dentro do ambiente de risco da sala de ressonância magnética. Estudos futuros são necessários para confirmar sua segurança e eficiência em pacientes pediátricos.

Ventilación jet durante microcirugía de múltiples mixomas laríngeos en paciente con vía respiratoria anatómicamente difícil / Jet ventilation during microsurgery of multiple laryngeal myxomas in a patient with anatomically difficult respiratory airway

Introducción: La microcirugía de laringe incluye el dilema de un campo quirúrgico que coincide espacialmente con el del acceso a la vía respiratoria del paciente. Los mixomas, sobre todo numerosos y supra-infraglóticos, representan un reto terapéutico. Si aunado a este hecho, el paciente presenta una vía respiratoria anatómicamente difícil, la fórmula de la catástrofe sólo precisa mezclarlos con un plan de ventilación convencional. En este caso, la ventilación jet puede ser la alternativa para evitar una situación de desastre. Objetivo: Describir la secuencia de hechos y los resultados al aplicar por primera vez en el país la ventilación jet vía transcricotiroidea. Caso clínico: Ante el fracaso previo de una intervención mediante un método tradicional de ventilación, en una segunda intención para exéresis de múltiples mixomas laríngeos en una paciente con vía respiratoria anatómicamente difícil, después de obtener su consentimiento informado, se procedió a anestesiar y obtener un acceso transcricotiroideo a la vía respiratoria, para ventilar con flujos jet a través de un trocar 16G. La intervención, pensada para 15 min, se extendió durante 90 sin complicaciones ventilatorias o de oxigenación. La paciente fue dada de alta sin secuelas. Conclusiones: Aplicar ventilación jet vía transcricotiroidea fue oportuno, seguro y efectivo. Las complicaciones cardiovasculares menores fueron fácilmente controlables. Se usó por primera vez la ventilación jet transcricotiroidea en el país. Este resultado estimula la asimilación de las tecnologías de ventilación jet en contextos electivos o emergentes, como el desafío de una vía respiratoria anatómicamente difícil(AU)

Introduction: The larynx microsurgery involves the dilemma of a surgical field that coincides spatially with that of access to the patient's airway. Myxomas, especially numerous and supra/subglottic, represent a therapeutic challenge. If together with this fact, the patient presents an anatomically difficult airway, the formula for the catastrophe just needs to mix both with a conventional ventilation plan. In this case, jet ventilation can be the choice to avoid a disaster situation. Objective: To describe the sequence of events and the outcomes when transcricotyroid jet ventilation was applied for the first time in the country. Clinical case: In the face of previous failure of an intervention using a traditional method of ventilation, in a second intention for exeresis of multiple laryngeal myxomas in a patient with anatomically difficult airway, after obtaining her informed consent, we proceeded to anesthetize to obtain a transcricothyroid access to the respiratory tract, to ventilate with jet flows through a 16G trocar. The intervention, planned for 15 min, was extended for 90 minutes without ventilatory or oxygenation complications. The patient was discharged without sequelae. Conclusions: Transcricotyroid jet ventilation was timely, safe and effective. Minor cardiovascular complications were easily controllable. Transcricotyroid jet ventilation was used for the first time in the country. This outcome stimulates the assimilation of jet ventilation technologies in elective or emerging contexts, such as the challenge of an anatomically difficult airway(AU)

Use of a trans-tracheal rapid insufflation of oxygen device in a “cannot intubate, cannot oxygenate” scenario in a parturient: a case report / 대한마취과학회지

BACKGROUND: The trans-tracheal rapid insufflation of oxygen (TRIO) device is less commonly used and is an alternative to trans-tracheal jet ventilation for maintaining oxygenation in a “cannot intubate, cannot oxygenate” (CICO) scenario. CASE: We report the successful use of this device to maintain oxygenation after jet ventilator failure in a parturient who presented with the CICO scenario during the procedure for excision of laryngeal papilloma. CONCLUSIONS: A stepwise approach to the airway plan and preparation for an event of failure is essential for good materno-fetal outcomes. The TRIO device may result in inadequate ventilation that can lead to hypercarbia and respiratory acidosis. Hence, it should only be used as a temporizing measure before a definitive airway can be secured.

Seguridad y efectividad de la ventilación a chorro con frecuencias ventilatorias convencionales para microcirugía laríngea electiva / Safety and effectiveness of jet ventilation with conventional ventilatory frequencies for elective microlaryngeal surgery

Introducción: La ventilación al paciente durante la microcirugía laríngea confronta varios problemas. La ventilación a chorro tipo jet con frecuencias ventilatorias convencionales permite usar catéteres endotraqueales de pequeño diámetro para aportar volúmenes adecuados de oxígeno y proporciona mejores condiciones operatorias que el método tradicional. Objetivo: Evaluar la seguridad y efectividad de la ventilación jet con frecuencias ventilatorias convencionales para microcirugía laríngea electiva en comparación con la ventilación convencional. Métodos: Se realizó un estudio comparativo, a simple ciego, aleatorizado y paralelo. Se trabajó con un prototipo de dispositivo de ventilación jet con permiso de uso excepcional en seres humanos (autorización excepcional No: 004/17 para realización de estudio piloto, con fecha 2 de agosto de 2017, conferido por el CECMED). Se utilizó un grupo estudio de 45 pacientes (grupo E) y se comparó con un grupo control (grupo C) de 15 pacientes ventilados mediante el método tradicional. Resultados: La oxigenación resultó superior dentro del grupo E. El grupo C requirió eventualmente de extubación, apnea transitoria y reintubación, lo que repercutió en contra de la integridad anatomofisiológica de los pacientes, del campo operatorio y la docencia. Fue evidente una mayor estabilidad hemodinámica entre los sujetos del grupo E. Las presiones intrapulmonares producidas por la ventilación jet no provocaron lesiones ni repercusión clínica evidentes. Conclusiones: Aplicar la ventilación a chorro con frecuencias ventilatorias convencionales fue seguro y efectivo. Por primera vez se obtienen experiencias de utilización de un método de ventilación jet en el país. El grupo en el que se aplicó la ventilación convencional sufrió complicaciones más frecuentes y peligrosas. Es necesario asimilar las tecnologías de ventilación jet para elevar la calidad de la atención médica en tiempos de paz, de guerra o desastres, en contextos electivos, o emergentes como el desafío de una vía respiratoria difícil(AU)

Introduction: Ventilation to the patient during microlaryngeal surgery confronts several problems. Jet ventilation with conventional ventilatory frequencies allows the use of small diameter endotracheal catheters to provide adequate oxygen volumes and provide better operating conditions than the traditional method. Objective: To evaluate the safety and effectiveness of jet ventilation with conventional ventilatory frequencies for elective microlaryngeal surgery in comparison to conventional ventilation. Methods: A comparative, single-blind, randomized and parallel study was performed. It was used a prototype of jet ventilation device with an exceptional use permit in humans (exceptional authorization No: 004/17 for conducting a pilot study, dated August 2, 2017, conferred by the CECMED). A study group of 45 patients (group E) was used and compared with a control group (group C) of 15 patients using the traditional ventilation method. Results: Oxygenation was higher in group E. Group C eventually required extubation, transitory apnea and reintubation, which impacted against the anatomophysiological integrity of patients, the operative field and teaching. A greater hemodynamic stability was evident among the subjects of group E. The intrapulmonary pressures produced by jet ventilation did not cause obvious injuries or clinical repercussions. Conclusions: Applying jet ventilation with conventional ventilatory frequencies was safe and effective. For the first time, experiences of using a jet ventilation method in the country were obtained. The group in which conventional ventilation was applied suffered more frequent and dangerous complications. It is necessary to assimilate jet ventilation´s technologies to raise the quality of medical attention in times of peace, war or disasters, in elective or emerging contexts as the challenge of a difficult airway(AU)

High-flow nasal cannula oxygenation for everyone? Not so fast / ¿Oxigenación con cánula nasal de alto flujo para todos? No tan rápido

No disponible

High-flow nasal cannula therapy versus non-invasive ventilation in children with severe acute asthma exacerbation: An observational cohort study / Oxigenoterapia de alto flujo frente a ventilación no invasiva en niños con estatus asmático: estudio observacional de cohortes

Introduction: The present study describes our experience with the high-flow humidified nasal cannula (HFNC) versus non-invasive ventilation (NIV) in children with severe acute asthma exacerbation (SA). Methods: An observational study of a retrospective cohort of 42 children with SA admitted to a Pediatric Intensive Care Unit (PICU) for non-invasive respiratory support was made. The primary outcome measure was failure of initial respiratory support (need to escalate from HFNC to NIV or from NIV to invasive ventilation). Secondary outcome measures were the duration of respiratory support and PICU length of stay (LOS). Results: Forty-two children met the inclusion criteria. Twenty (47.6%) received HFNC and 22 (52.3%) NIV as initial respiratory support. There were no treatment failures in the NIV group. However, 8 children (40%) in the HFNC group required escalation to NIV. The PICU LOS was similar in both the NIV and HFNC groups. However, on considering the HFNC failure subgroup, the median length of respiratory support was 3-fold longer (63h) and the PICU LOS was also longer compared with the rest of subjects exhibiting treatment success. Conclusions: Despite its obvious limitations, this observational study could suggest that HFNC in some subjects with SA may delay NIV support and potentially cause longer respiratory support, and longer PICU LOS (AU)

Introducción: El objetivo de este estudio es comparar nuestra experiencia con el uso de oxigenoterapia de alto flujo (OAF) frente a la ventilación no invasiva (NIV) en niños con estatus asmático (EA). Métodos: Estudio observacional de una cohorte retrospectiva de 42 niños con EA ingresados en nuestra Unidad de Cuidados Intensivos Pediátricos (UCIP) con soporte respiratorio no invasivo. El objetivo principal del estudio fue valorar el éxito/fracaso del soporte respiratorio inicial (necesidad o no de escalar a un soporte respiratorio superior). El objetivo secundario fue comparar la duración del soporte respiratorio y del ingreso en la UCIP. Resultados: Cuarenta y dos niños cumplieron con los criterios de inclusión. Veinte (47,6%) fueron tratados con OAF y 22 (52,3%) con VNI como soporte respiratorio inicial. No hubo fracaso terapéutico en el grupo VNI, si bien 8 niños (40%) del grupo OAF fueron cambiados a VNI. La duración de la estancia en la UCIP y en el hospital fue similar en ambos grupos NIV y HFNC. Sin embargo, en el subgrupo de fracaso de OAF, la duración del soporte respiratorio (el triple, 63h) y la estancia en la UCIP fueron mucho mayores en comparación con los sujetos que tuvieron éxito en el tratamiento. Conclusiones: Este estudio observacional, con sus evidentes limitaciones, podría sugerir que el uso de HFNC en algunos sujetos con EA puede retrasar el inicio de la VNI y potencialmente causar un soporte respiratorio más prolongado y una mayor estancia en la UCIP (AU)

Alto flujo en pacientes postrasplantados de pulmón / High Flow Therapy in Post-Lung Transplant Patients

No disponible

Comparison of the Effectiveness of Different Supraglottic Ventilation Methods during Bronchial Thermoplasty / 中国医学科学院学报

<p><b>OBJECTIVE</b>To compare the effectiveness of high-frequency jet ventilation via Wei jet nasal airway and controlled ventilation with improved laryngeal mask airway during bronchial thermoplasty.</p><p><b>METHODS</b>Twenty-eight patients undergoing bronchial thermoplasty were equally divided into two groups: group A (high-frequency jet ventilation through Wei jet nasal airway) and group B (controlled ventilation with improved laryngeal mask airway). Pulse oxygenation,heart rate,and mean arterial blood pressure were recorded after entering the operating room (T0), 1 minute after administration/induction (T1), bronchoscope inserting (T2), 15 minutes (T3)/30 minutes (T4)/45 minutes (T5) after ventilation,at the end of the operation (T6), and at the recovery of patients' consciousness (T7). The pH,arterial oxygen partial pressure,and arterial carbon dioxide partial pressure were recorded at T0, T4, and T6. The endoscope indwelling duration,operative time,patients' awakening time,adverse events during anesthesia,satisfactions of patients and operators, anesthesic effectiveness were also recorded.</p><p><b>RESULTS</b>The arterial carbon dioxide partial pressur in group A at T4 and T6 were significantly higher than in group B (P<0.05). The pH in group A at T4 and T6 was significantly lower than in group B (P<0.05). The endoscope indwelling duration and the operative time in group B were significantly shorter than in group A (P<0.05) while the recovery of consciousness in group B was significantly longer than in group A (P<0.05). The satisfaction for operators and the efficacy of anesthesia in group B were better than in group A (P<0.05). The number of adverse events in group B was significantly smaller than in group A (P<0.05).</p><p><b>CONCLUSION</b>The improved laryngeal mask airway with controlled ventilation is more suitable for bronchial thermoplasty.</p>

Efficacy of target-controlled infusion of propofol and remifentanil with high frequency jet ventilation in fibre-optic bronchoscopy

<p><b>INTRODUCTION</b>Sedation or anaesthesia is recommended for all patients undergoing bronchoscopy unless absolute contraindications exist. However, the widely used combination of propofol and opiates for moderate sedation (MS) in bronchoscopy results in a high incidence of hypoxaemia and a relatively high cough score during the procedure. In this study, we evaluated the efficacy and safety of target-controlled infusion (TCI) of propofol and remifentanil, together with the use of high frequency jet ventilation (HFJV), to achieve general anesthesia (GA) in diagnostic fibre-optic bronchoscopy.</p><p><b>METHODS</b>A total of 92 consecutive patients scheduled for flexible bronchoscopy were randomly assigned to receive either MS using TCI-delivered propofol and remifentanil (n = 46), or GA using TCI-delivered propofol and remifentanil with HFJV (n = 46). The following were compared between the MS and GA groups: incidence of hypoxaemia, cough score, haemodynamic parameters, partial pressure of carbon dioxide in arterial blood, duration of bronchoscopy and patient satisfaction score.</p><p><b>RESULTS</b>The average and minimum oxygen saturation values in the MS group were lower than those in the GA group. The MS group showed a higher incidence of hypoxaemia. There was no significant difference in the partial pressure of carbon dioxide between the two groups. Cough score and duration of the bronchoscopy were markedly lower in the GA group, and patient satisfaction score was higher in the GA group.</p><p><b>CONCLUSION</b>GA, achieved via TCI-delivered propofol and remifentanil with HFJV, provides better conditions for diagnostic bronchoscopy - it decreases the occurrence of hypoxaemia, shortens the duration of bronchoscopy and increases patient satisfaction.</p>

Manujet III manual jet ventilation used in tracheobronchial foreign bodies removal in children / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To evaluate the effect of applying Manujet III manual jet ventilation to remove tracheo-bronchial foreign bodies in children.@*METHOD@#Before 2009, 62 patients, using the controlled positive pressure ventilation through the side holes of the rigid bronchoscopy, is signed as group P. Another group J ,from January 2009 to January 2012, 48 cases, utilizing Manujet III device manual jet ventilation. The satisfaction rate at placed in bronchoscopy, intraoperative hypoxia. removal of foreign body situation, operative time, incidence of adverse reactions were recorded and contrasted.@*RESULT@#The difference of satisfaction rate in placing endoscopy between the two groups was not statistically significant (P>0.05). But in operative time, intraoperative hypoxia, incidence of adverse reaction rate was statistically significant (P<0.05), J group is better than the group P.@*CONCLUSION@#In the tracheobronchial foreign bodies removal, application Manujet III device to manual jet ventilation can reduce the incidence of intraoperative hypoxia, easier to surgical operation.

Medición del volumen corriente en ventilación de alta frecuencia / Measuring tidal volume during paediatric oscillatory and jet high-frequency ventilation

Objetivo: Valorar si un espirómetro puede medir el volumen corriente en ventilación de alta frecuencia oscilatoria (VAFO) y por jet (VAFJ) y analizar el efecto de los cambios en los parámetros del respirador. Métodos: Se realizó un estudio con pulmones de prueba pediátricos y en cerdos. Para la VAFO se utilizó el respirador Sensormedics 3100BR y para la VAFJ el respirador Paravent PateR. La medición del volumen corriente (VC) se realizó con un espirómetro D-Fend. Se realizaron cambios en la frecuencia, amplitud y presión media en la vía aérea (PMVA), registrándose los cambios en el VC y las presiones. Resultados: El espirómetro midió el VC en los pulmones de prueba y en los cerdos, pero no pudo medir VC menores de 8 ml, cuando la amplitud era mayor de 55 cmH2O o la PMVA mayor de 30 cmH2O. En la VAFO existió una correlación entre la amplitud y el VC y en la VAFJ entre la presión y el VC. En ambos respiradores existió una correlación negativa entre la frecuencia y el VC. Conclusiones: El espirómetro D-Fend puede medir el volumen corriente durante la VAFO y la VAFJ, pero no es capaz de medir VC menores de 8 o cuando se utilizan amplitudes o presiones elevadas (AU)

Objective: To as certain whether a spirometer can measure tidal volume (TV) during high frequency oscillatory ventilation (HFOV) and high frequency jet ventilation (HFJV), and to analyse the effect of changes in ventilator settings. Methods: The study was performed with paediatric porcine lung models submitted to HFOV with a Sensormedics 3100 ventilator and HFJV with a Paravent Pate R ventilator connected to a D-Fend spirometer. Programmed frequency, amplitude, and mean airway pressure (MAP) were changed in the ventilator, and TV and pressures were recorded using the spirometer. Results: The spirometer measured TV in the paediatric lung models and piglets, but could not measure TV less than 8 ml, when the pressure amplitude was higher than 55 cmH2O or the MAP was higher than 30 cmH2O. With HFOV there was a correlation between amplitude and tidal volume, and a positive correlation between pressure and TV with HFJV. With both respirators there was a negative correlation between frequency and TV. Conclusions: The D-Fend spirometer can measure tidal volume and pressure during HFOV and HFJV. However, it does not work with volumes lower than 8 ml, and high amplitude or mean airway pressure (AU)

The effect of positive-end expiratory pressure on oxygenation during high frequency jet ventilation and conventional mechanical ventilation in the rabbit model of acute lung injury / 대한마취과학회지

BACKGROUND: The use of positive end expiratory pressure (PEEP) in patients with acute lung injury (ALI) improves arterial oxygenation by alleviating pulmonary shunting, helping the respiratory muscles to decrease the work of breathing, decreasing the rate of infiltrated and atelectatic tissues, and increasing functional residual capacity. In a rabbit model of saline lavage-induced ALI, we examined the effects of PEEP on gas exchange, hemodynamics, and oxygenation during high frequency jet ventilation (HFJV), and then compared these parameters with those during conventional mechanical ventilation (CMV). METHODS: Twelve rabbits underwent repeated saline lavage to create ALI. The animals were divided in 2 groups: 1) Group CMV (n = 6), and 2) Group HFJV (n = 6). In both groups, we applied 2 levels of PEEP (5 cmH2O and 10 cmH2O) and then measured the arterial blood gas, mixed venous blood gas, and hemodynamic parameters. RESULTS: With administration of PEEP of either 5 cmH2O or 10 cmH2O, the arterial oxygen content of both groups was increased, although without statistically significant differences between groups. On the contrary, the arterial carbon dioxide content was significantly decreased in the HFJV group, as compared with the CMV group, during the entire experiment. Furthermore, there was significant decreases in mean arterial pressures in both groups with a PEEP of 10 cmH2O. CONCLUSIONS: The application of PEEP in rabbits with ALI effectively improves oxygenation in either HFJV or CMV.

Ventilación mecánica: [revisión] / Mechanical ventilation: [review]

La ventilación mecánica (VM) es un recurso terapéutico de soporte vital, que ha contribuido decisivamente en mejorar la sobrevida de los pacientes en estado crítico, sobre todo aquellos que sufren insuficiencia respiratoria aguda (IRA). La mejor comprensión de los procesos fisiopatológicos y los recientes avances informáticos que han mejorado los ventiladores mecánicos, facilitan el tratamiento de estos pacientes. Este artículo tiene como objetivo la descripción en forma práctica de la VM, involucrando una explicación del mismo ventilador, sus componentes, sus funciones, así como los efectos fisiológicos que se producen al someter a un paciente a la VM. También se reseñan las indicaciones, cómo y por qué programar los diferentes parámetros del soporte, incluyendo una explicación grafica de los modos ventilatorios más frecuentemente usados y la monitorización multimodal que nos permite optimizar el manejo en forma individual para cada situación; además se detallan las complicaciones más frecuentes y en forma sucinta se describe el desteteo descontinuación de la VM. Por último, se revisan los pormenores del transporte de los pacientes con soporte ventilatorio y se repasan los medicamentos más usados en la sedación y analgesia.

Mechanical ventilation (MV) is a therapeutic resource of life support, which has been instrumental in improving survival in critically ill patients, especially those suffering acute respiratory failure. A better understanding of pathophysiological phenomena and recent advances in technology had facilitated therapy for such patients. The aim of this paper is to describe MV using a practical approach, explaining how a mechanical ventilator works, together with its components and its functioning mechanisms, also considering the physiological effects that occur when we put a patient in MV.

Ventilación mecánica / Mechanical Ventilation

La ventilación mecánica (VM) es un recurso terapéutico de soporte vital, que ha contribuido decisivamente en mejorar la sobrevida de los pacientes en estado crítico, sobre todo aquellos que sufren insuficiencia respiratoria aguda (IRA). La mejor comprensión de los procesos fisiopatológicos y los recientes avances informáticos que han mejorado los ventiladores mecánicos, facilitan el tratamiento de estos pacientes. Este artículo tiene como objetivo la descripción en forma práctica de la VM, involucrando una explicación del mismo ventilador, sus componentes, sus funciones, así como los efectos fisiológicos que se producen al someter a un paciente a la VM. También se reseñan las indicaciones, cómo y por qué programar los diferentes parámetros del soporte, incluyendo una explicación grafica de los modos ventilatorios más frecuentemente usados y la monitorización multimodal que nos permite optimizar el manejo en forma individual para cada situación; además se detallan las complicaciones más frecuentes y en forma sucinta se describe el desteteo descontinuación de la VM. Por último, se revisan los pormenores del transporte de los pacientes con soporte ventilatorio y se repasan los medicamentos más usados en la sedación y analgesia.

Mechanical ventilation (MV) is a therapeutic resource of life support, which has been instrumental in improving survival in critically ill patients, especially those suffering acute respiratory failure. A better understanding of pathophysiological phenomena and recent advances in technology had facilitated therapy for such patients. The aim of this paper is to describe MV using a practical approach, explaining how a mechanical ventilator works, together with its components and its functioning mechanisms, also considering the physiological effects that occur when we put a patient in MV.

High Frequency Jet Ventilation of One Lung using a Bronchial Blocker of Univent during Carinal Resection

Airway management during carinal resection should provide adequate ventilation and oxygenation as well as a good surgical field, but without complications such as barotraumas or aspiration. One method of airway management is high frequency jet ventilation (HFJV) of one lung or both lungs. We describe a patient undergoing carinal resection, who was managed with HFJV of one lung, using a de-ballooned bronchial blocker of a Univent tube without cardiopulmonary compromise. HFJV of one lung using a bronchial blocker of a Univent tube is a simple and safe method which does not need additional catheters to perform HFJV and enables the position of the stiffer bronchial blocker more stable in airway when employed during carinal resection.