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GENERAL ARTICLES

High Frequency Jet Ventilation in Interventional Fiberoptic Bronchoscopy

Hubert Hautmann, MD^*, Fernando Gamarra, MD^*, Markus Henke, MD^*, Stephanie Diehm, MD, and Rudolf M. Huber, MD^*

*Medizinische Klinik, Klinikum Innenstadt, Klinikum Großhadern/Klinikum Innenstadt, Klinik für Anästhesie, Ludwig-Maximilians-University, Munich, Germany

Address correspondence and reprint requests to Dr.med. Hubert Hautmann, MD, Klinikum Innenstadt, Medizinische Klinik, Ziemssenstr.1, D-80336 München, Germany. Address e-mail to hautmann{at}medinn.med.uni-muenchen.de

High frequency jet ventilation (HFJV) is a well accepted method for securing ventilation in rigid and interventional bronchoscopy. We describe a technique of HFJV using a 14F nylon insufflation catheter placed in the trachea to support stent implantation or endobronchial balloon dilation in endobronchial stenoses with the flexible fiberscope. One hundred sixty-one cases were treated with either a metal wire stent (n = 105) or with balloon dilation (n = 56). In addition to HFJV, IV anesthesia was applied in 132 cases. Driving pressure was 1125–1275 mm Hg, frequency 80–100/min, and inspiratory:expiratory ratio of 1:2. Fraction of inspired oxygen ranged from 0.3–1.0. The effects on alveolar ventilation were assessed by using blood-gas analysis and continuous monitoring of transcutaneous oxygen and carbon dioxide tension (P_tcCO₂). Complications consisted of hypertension (n = 8), hypotension (n = 6), bronchospasm (n = 5), and hypoxia (n = 6). In 52% of the cases, mild hypercarbia (P_tcCO2 50–60mm Hg) was observed. In two cases, a P_tcCO₂ > 80mm Hg resolved spontaneously when the patients returned to normal breathing after intermittent superimposed ventilation with a face mask. During placement of stents in the proximal trachea, the jet catheter had to be withdrawn, resulting in displacement of the catheter into the pharynx in one case, which was managed safely with the bronchoscope. In conclusion, HFJV achieves satisfactory operating conditions and provides adequate gas exchange for interventional bronchoscopic procedures with the fiberscope.

Implications: Safe ventilation is desired when performing tracheobronchial stent implantation and balloon dilation with the fiberscope. High frequency jet ventilation, applied with a 14F insufflation catheter through the nasotracheal route, offers safe ventilatory support with minimal complications. This was evaluated in 161 procedures treating benign and malignant airway stenoses.

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