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Recognition and Management of the Difficult Airway
Published in John C Watkinson, Raymond W Clarke, Louise Jayne Clark, Adam J Donne, R James A England, Hisham M Mehanna, Gerald William McGarry, Sean Carrie, Basic Sciences Endocrine Surgery Rhinology, 2018
Valerie Cunningham, Alistair McNarry
It is best considered by its nature (high- or low-frequency) and by its position (supraglottic, subglottic or transtracheal). Delivery of each of these has advantages and disadvantages. High-frequency jet ventilation is defined as a respiratory rate of between 1 and 10 Hz and requires the use of a specific device. Low-frequency jet ventilation can be delivered by a Manujet (VBM) at a lower rate (Figure 31.24). More complex modes of jet ventilation are described. Superimposed High-Frequency Jet Ventilation combines HFJV with LFJV and has been shown to be effective in patients and offers potential benefits in terms of end-expiratory volumes.60, 61
Thoracic surgery
Published in Brian J Pollard, Gareth Kitchen, Handbook of Clinical Anaesthesia, 2017
Fibreoptic bronchoscopy has largely superseded rigid bronchoscopy for the diagnosis of lung disease. It is used for therapeutic manoeuvres such as removal of a foreign body, stent insertion or debulking of airway tumour. Ventilation during bronchoscopy is achieved with a Venturi injector or ventilating bronchoscope. High-frequency jet ventilation is popular in some other countries but not used widely in the UK.
Postoperative management of the surgical neonate
Published in Prem Puri, Newborn Surgery, 2017
Increased understanding of the importance of limiting peak pressures when inflating the lungs has led to the widespread use of high-frequency oscillatory ventilation (HFOV). 13,14 This mode of ventilation recruits alveoli to participate in gas exchange, keeping the lung open with a constant distending pressure. This is sometimes referred to as the “open lung” approach. Excretion of carbon dioxide is managed by adjustments to the frequency and magnitude of oscillation, and oxygenation is achieved by adjusting the mean airway pressure and the inspired content of oxygen.15 Recruitment and stabilization of lung volumes is both pressure and time dependent.16 In 1996, the prospective randomized trial of high frequency oscillatory ventilation versus conventional ventilation (PROVO) trial used a clearly defined lung recruitment protocol with all patients receiving surfactant and demonstrated a reduction in hospital length of stay and the incidence of chronic lung disease.17 Commencing HFOV early rather than after lung damage has been sustained appears to improve outcome, especially in premature infants. 14,17 Some relevant features of HFOV and high-frequency jet ventilation (HFJV) are summarized in Table 12.2.
Effects of human tissue acoustic properties, abdominal wall shape, and respiratory motion on ultrasound-mediated hyperthermia for targeted drug delivery to pancreatic tumors
Published in International Journal of Hyperthermia, 2022
Michael Gray, Laura Spiers, Constantin Coussios
Simulations illustrating the effects of respiratory motion were carried out using patient model M1 with target displacements induced under normal respiration and with high frequency jet ventilation (HFJV) according to the parameters listed in Section 2.5. To begin the analysis, Figure 10 shows the temperature elevation after a single half-line beam trajectory has been completed (see Figure 3). For the simulations presented in the prior sections this represents the thermal response after 4.7 s of heat deposition spanning one-quarter of a slice of hyperthermia treatment. In Figure 10, temperature elevations within and outside the treatment slice are shown in the upper row, and the beam trajectories without (red) and with respiratory motion (blue) are shown as a function of time in the lower row.
Managing respiratory complications in infants and newborns with congenital diaphragmatic hernia
Published in Expert Opinion on Orphan Drugs, 2020
Sandeep Shetty, Fahad M. S. Arattu Thodika, Anne Greenough
High-frequency oscillatory ventilation is considered as rescue therapy, if the infant is difficult to ventilate and required peak airway pressures more than 25–28 cm H2O [58,62]. The starting oscillatory settings suggested are a mean airway pressure of between 13 and 17 cmH2O, a frequency of 10 Hz and a delta P of 30–50 cmH2O depending on chest rise [58,62]. Caution must be taken to monitor hyperinflation of the lungs, as high mean airway pressures can cause pneumothoraces and reduce venous return and cardiac output [74]. The VICI trial was a randomized trial involving nine centers in the CDH EURO consortium. The trial compared conventional mechanical ventilation (CMV) to high-frequency oscillatory ventilation (HFOV) as the initial mode of ventilation. There was no statistical significant difference in the primary outcome which was death or bronchopulmonary dysplasia at 28 days between the ventilation groups. The CMV group, however, required a shorter duration of ventilation and vasoactive medication and were less likely to require other medications to treat pulmonary hypertension or require ECMO [75]. There are limited data on the use of high-frequency jet ventilation in infants with CDH, but it has been used as a rescue ventilation mode during transport [76].
Advances in interventional diagnostic bronchoscopy for peripheral pulmonary lesions
Published in Expert Review of Respiratory Medicine, 2019
Tsukasa Ishiwata, Alexander Gregor, Terunaga Inage, Kazuhiro Yasufuku
With deeper sedation, adequate ventilatory support is often required. High frequency jet ventilation (HFJV) has been often employed for rigid bronchoscopy. Recently, several institutions have looked to employ HFJV for flexible bronchoscopy as an adjunct for complex bronchoscopic procedures. The advantage of HFJV is that it allows effective gas transport without high airway pressures. Hautmann and colleagues performed interventional flexible bronchoscopy in 161 patients with HFJV using a nylon catheter placed via the nasotracheal route [85]. They showed that the rate of hypoxia (pO2 < 60 mmHg) was very low (3.7%), though hypercapnia frequently occurred. A study by Abedini and colleagues conducted HFJV via the working channel of the bronchoscope in non-intubated patients with oxygen desaturation that did not resolve with nasal oxygen supplementation [86]. They showed a significant improvement in arterial oxygenation and carbon dioxide tension in a case series including 16 patients. This method may be useful during diagnostic bronchoscopy, but more robust comparative studies are needed for characterizing any potential benefit.