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GENERAL ARTICLES

Comparing Methods of Administering High-Frequency Jet Ventilation in a Model of Laryngotracheal Stenosis

University Department of Anaesthesia, Critical Care & Pain Management, Leicester Royal Infirmary, Leicester, United Kingdom

Address correspondence to Dr. A. Ng and reprint requests to Dr. J. P. Thompson, University Department of Anaesthesia, Critical Care & Pain Management, Leicester Royal Infirmary, Leicester LE1 5WW, UK. Address e-mail (Dr. Ng) to anae{at}le.ac.uk

We administered high-frequency jet ventilation (HFJV) to a tracheal-lung model with connectors of internal diameter 2.5–8.5 mm to simulate ventilation through varying degrees of laryngotracheal stenosis. With reductions in diameter, end-expiratory pressure (EEP) and peak inspiratory pressure (PIP) increased. During supraglottic, translaryngeal, and transtracheal HFJV, respectively, EEP was 10 mm Hg at diameters narrower than 5.5, 4.0, and 3.5 cm, and PIP was >20 mm Hg at diameters narrower than 5.5, 3.5, and 3.0 cm. EEP and PIP were greater during supraglottic HFJV than during translaryngeal and transtracheal HFJV (P < 0.01). At diameters of <3.5 and 4.0 cm, respectively, PIP and EEP increased and were significantly greater (P < 0.01) during translaryngeal HFJV than during transtracheal HFJV. In a second experiment, the degree of ventilation and air entrainment was assessed by administering nitrous oxide 4 L/min to the model. Nitrous oxide concentrations were significantly (P < 0.01) smaller and nitrogen concentrations were significantly (P < 0.01) larger during supraglottic HFJV than either translaryngeal or transtracheal HFJV. The larger EEP and PIP associated with supraglottic HFJV may be attributable to increased ventilation and air entrainment compared with translaryngeal and transtracheal HFJV.

IMPLICATIONS: Ventilatory driving pressure during supraglottic high-frequency jet ventilation may be reduced to minimize high airway pressures and hence the potential for pulmonary barotrauma in patients with laryngotracheal stenosis.

This article has been cited by other articles:

				P. W. Buczkowski, F. N. Fombon, E. S. Lin, W. C. Russell, and J. P. Thompson Air entrainment during high-frequency jet ventilation in a model of upper tracheal stenosis Br. J. Anaesth., December 1, 2007; 99(6): 891 - 897. [Abstract] [Full Text] [PDF]

				P. W. Buczkowski, F. N. Fombon, W. C. Russell, and J. P. Thompson Effects of helium on high frequency jet ventilation in model of airway stenosis Br. J. Anaesth., November 1, 2005; 95(5): 701 - 705. [Abstract] [Full Text] [PDF]

Anesthesia & Analgesia® is published for the International Anesthesia Research Society® by Lippincott Williams & Wilkins with the assistance of Stanford University Libraries' HighWire Press®. Copyright 2006 by the International Anesthesia Research Society. Online ISSN: 1526-7598   Print ISSN: 0003-2999