BACKGROUND: Hypoxemia during one lung ventilation (OLV) may occur in spite of high inspired oxygen concentration. The purpose of this study was to evaluate the effect of highfrequency jet ventilation (HFJV) alone to the non-ventilated lung or in combination with 5 cmH2O of positive end expiratory pressure (PEEP) to the ventilated lung on arterial oxygenation (PaO2) during OLV for thoracic surgery. METHODS: After endotracheal intubation with double lumen tube, arterial blood gases were measured 20 minutes after stabilization had occurred following onset of OLV, HFJV, and HFJV with 5 cmH2O of PEEP. RESULT: The mean PaO2 during OLV was 257.5+/-81.7 mmHg, and application of HFJV alone or with PEEP resulted in a significant increase in PaO2 to 356.6+/-79.1 mmHg and 354.9+/-66.6 mmHg, respectively (p<0.001). Alveolar-arterial oxygen differences were significantly decreased as compared to OLV. CONCLUSION: Both HFJV alone or in combination with 5cmH2O of PEEP are effective to improve oxygenation during OLV.
Anoxia ; Gases ; High-Frequency Jet Ventilation* ; Intubation, Intratracheal ; Lung ; One-Lung Ventilation* ; Oxygen* ; Positive-Pressure Respiration* ; Thoracic Surgery ; Ventilation

The incidence of tracheal stenosis is increased because of the longterm respiratory care with endotracheal intubation and tracheostomy. Present therapeutic modalities for the relief of an tracheal or bronchial stenosis include laser resection, radiotherapy, cryotherapy, bougienation, stent insertion, dilatation with balloon catheter and finally reconstruction surgery. However, reconstruction surgery have some problems in ventilation during anesthetic management. Small sized tube insertion through lesion, high frequency jet ventilation, cardiopulmonary bypass are served to resolve ventilatory problem. We experienced a case of severe tracheal stenosis due to tracheostomy. The stenotic lesion was 2.5 cm above the carina, 3 mm in diameter and length of the stenotic segment was 1 cm. We used bougienation with endotracheal tube replace obturator for the ventilation before the reconstruction surgery and the patient was successfully managed without complications.
Airway Management* ; Cardiopulmonary Bypass ; Catheters ; Constriction, Pathologic ; Cryotherapy ; Dilatation ; High-Frequency Jet Ventilation ; Humans ; Incidence ; Intubation, Intratracheal ; Radiotherapy ; Stents ; Trachea ; Tracheal Stenosis* ; Tracheostomy ; Ventilation

In tracheal stenosis, airway management is most challenging for anesthesiologists. A small sized endotracheal tube, laryngeal mask airway, with high frequency jet ventilation can be used, but may result in ineffective oxygenation and ventilation. In such cases, extracorporeal life support, ECLS, can be helpful. Herein, a case of tracheal stenosis in an adult assisted with the ECLS is reported.
Adult ; Airway Management ; High-Frequency Jet Ventilation ; Humans ; Laryngeal Masks ; Oxygen ; Tracheal Stenosis* ; Ventilation

BACKGROUND: In some cases of one-lung ventilation (OLV), hypoxemia may occur secondarily to the obligatory right to left transpulmonary shunt through the collapsed lung. We investigated the efficacy of high frequency jet ventilation (HFJV) to the non-dependent lung which rendered to be manually collapsed by surgeon and not to be reinflated, in improving systemic oxygenation and ventilation during OLV while ventilating the dependent lung with intermittent positive pressure ventilation. METHODS: Investigation was carried out on 20 ASA 2 or 3 patients who underwent thoracotomy in lateral decubitus position. The patients were randomly allocated into HFJV group (n = 11) or CPAP group (n = 9). In HFJV group, 20 minutes after OLV began, HFJV with driving pressure 1.0 bar, Ti 30%, and frequency 150 cycles/min, was applied to the non-dependent lung. In CPAP group, 5 cmH2O of CPAP was applied to the non-dependent lung without re-inflation. We compared the changes of PaO2, PaCO2, AaDO2 and pulmonary shunt, before and after HFJV or CPAP was applied to the non-dependent lung during OLV. RESULTS: AaDO2 and pulmonary shunt were decreased significantly and therefore, PaO2 was increased significantly when HFJV was applied to the non-dependent lung (P < 0.05, respectively). PaO2, AaDO2 and pulmonary shunt were not improved after 5 cmH2O of CPAP was applied to the non-dependent lung without re-inflation. In HFJV group, PaCO2 measured after HFJV was not decreased significantly compared with that before HFJV. CONCLUSIONS: HFJV to the non-dependent lung during OLV improved systemic oxygenation, even after the non-dependent lung collapsed completely but did not enhance CO2 elimination. 5 cmH2O of CPAP to the non-dependent lung, which was completely collapsed and not re-inflated, did not improve systemic oxygenation.
Anoxia ; High-Frequency Jet Ventilation* ; Humans ; Intermittent Positive-Pressure Ventilation ; Lung* ; One-Lung Ventilation* ; Oxygen* ; Thoracotomy ; Ventilation

Due to the increased use of tracheostomy and intermittent positive pressure ventilation, patients with trscheal stenosis have become more frequent. Recently we experienced a patient with tracheal stenosis who was tracheostomized upon admission, but unfortunately the stenotic lesion was located below the end of the tracheostomy tube. The stenotic lesion was l.6cm above the carina, its diameter was 0.5 cm, and the length of the stenotic segment was about 2cm, A3,5 mm(I.D.) endotracheal tube was passed through the stenotic lesion via the tracheostomy site, and high frequency jet ventilation was applied with a swivel connector. Immediately after the start of surgery, CO2retention occurred and the driving gas pressure increased from 4p to 5p psi, the I:E ratio from 1:2 to 1: 3, but the respiration rate (100 bpm) was maintained as before. CO2retention was relieved soon. Following end to end anastomosis a 6. 0 mm(I.D.) cuffed endotracheal tube was intubated orally and inhalation anesthesia using N2O-O2-Halothane was maintained until the surgery was completed.
Anesthesia, Inhalation ; Constriction, Pathologic ; High-Frequency Jet Ventilation ; Humans ; Intermittent Positive-Pressure Ventilation ; Respiratory Rate ; Tracheal Stenosis* ; Tracheostomy

Currently conventional modes of controlled mechanical ventilation, such as intermittent positive pressure ventilation (IPPV) and continuous positive pressure ventilation (CPPV), with high volumes and low rates are utilized for the rhythmic inflation of the lungs. Basically the functional characteristics of these systems have not changed since Bjork and Engstrom first reviewed them in 1955 (Bjork and Engstrom 1955; Sjostrand 1983). Impairment of cardiovascular function and increasing the incidence of barotrauma with high airway pressure were problems which have needed to be solved. Thus respiratory support using high rates and low tidal volumes of ventilation was given. High-frequency ventilation(HFV) is not totally new idea, prototypes of it are found in nature in humming birds, insects and newborn babies. Moreover, HFV was reported in 1915 by Handerson who said that an adequate gas exchange could take place with a tidal volume less than the anatomical deadspace. But since the introduction of HFV in 1967, the basic concept of respiratory physiology has changed (Sjostrand and Smith 1983). HFV has received much attention in the last 20 years, resulting in a considerable accumulation of information. Many experimental and clinical studies have detailed the potential advantages of HFV but indicate that much work needs to be done to define and clarify the clinical role of these techniques and suggest that the standardized, reliable equipment with safety systems be developed. The purpose of this review is not to offer definite information for further investigation, but simply to provide background information for a better understanding of the experimental and clinical results recently achieved by many other researchers. Limited foci are as follows: 1) Definition and classification of HFV. 2) Technical developments and considerations. 3) Physiologic aspects of HFV. 4) Clinical applications. 5) Comparative studies between IPPV and HFV. 6) Problems and looking ahead.
Comparative Study ; High-Frequency Jet Ventilation ; High-Frequency Ventilation*/classification ; Human ; Intermittent Positive-Pressure Ventilation

Currently conventional modes of controlled mechanical ventilation, such as intermittent positive pressure ventilation (IPPV) and continuous positive pressure ventilation (CPPV), with high volumes and low rates are utilized for the rhythmic inflation of the lungs. Basically the functional characteristics of these systems have not changed since Bjork and Engstrom first reviewed them in 1955 (Bjork and Engstrom 1955; Sjostrand 1983). Impairment of cardiovascular function and increasing the incidence of barotrauma with high airway pressure were problems which have needed to be solved. Thus respiratory support using high rates and low tidal volumes of ventilation was given. High-frequency ventilation(HFV) is not totally new idea, prototypes of it are found in nature in humming birds, insects and newborn babies. Moreover, HFV was reported in 1915 by Handerson who said that an adequate gas exchange could take place with a tidal volume less than the anatomical deadspace. But since the introduction of HFV in 1967, the basic concept of respiratory physiology has changed (Sjostrand and Smith 1983). HFV has received much attention in the last 20 years, resulting in a considerable accumulation of information. Many experimental and clinical studies have detailed the potential advantages of HFV but indicate that much work needs to be done to define and clarify the clinical role of these techniques and suggest that the standardized, reliable equipment with safety systems be developed. The purpose of this review is not to offer definite information for further investigation, but simply to provide background information for a better understanding of the experimental and clinical results recently achieved by many other researchers. Limited foci are as follows: 1) Definition and classification of HFV. 2) Technical developments and considerations. 3) Physiologic aspects of HFV. 4) Clinical applications. 5) Comparative studies between IPPV and HFV. 6) Problems and looking ahead.
Comparative Study ; High-Frequency Jet Ventilation ; High-Frequency Ventilation*/classification ; Human ; Intermittent Positive-Pressure Ventilation

BACKGROUND: We examined the effects of varying inspiratory to expiratory (I : E) ratio on gas exchange and hemodynamics during high frequency partial liquid ventilation (HFPLV), a combination of high frequency ventilation (HFV) and partial liquid ventilation (PLV), in a rabbit model of acute lung injury. METHODS: Twelve rabbits treated with repeated saline lavage were divided into two groups. In the HFPL group (n = 6), 6 ml/kg of perfluorodecaline was administered through the endotracheal tube. Rabbits in this group and in the HFJ group (n = 6) were treated with high frequency jet ventilation (HFJV) at I : E ratios of 1 : 1, 1 : 2, and 1 : 3 for 15 minutes, and arterial blood gas, mixed venous blood gas and hemodynamic parameters were measured. RESULTS: We observed no significant respiratory and hemodynamic differences between the two groups. At an I : E ratio of 1 : 1, the PaO2 was significantly higher, and the shunt rate and PaCO2 were significantly lower in both groups, compared with I : E ratios of 1 : 2 and 1 : 3. Cardiac output at the 1 : 3 I : E ratio was significantly higher than at 1 : 1. CONCLUSIONS: These findings indicate that, in this model, a 1 : 1 I : E ratio was superior for oxygenation and ventilation than I : E ratios of 1 : 2 or 1 : 3, while having no detrimental effects on hemodynamics.
Acute Lung Injury ; Cardiac Output ; Hemodynamics ; High-Frequency Jet Ventilation ; High-Frequency Ventilation ; Liquid Ventilation ; Oxygen ; Rabbits ; Therapeutic Irrigation ; Ventilation

Open tracheostomy has been indicated for patients who require prolonged mechanical ventilation or respiratory care in order to avoid lots of complications during long-term endotracheal intubation. Because there are a number of disadvantages and serious complications in standard open tracheostomy, a simpler, safe and minimally invasive procedure such as percutaneous dilatational tracheostomy (PDT) and translaryngeal tracheostomy (TLT) were introduced as an appropriate procedure that can be administered at bedside. In terms of prevention of complications, minimal invasive tracheostomy techniques are more advisable for post open heart surgery patients. After two failed attempts at respirator weaning, we experienced a successful TLT for a 71-year-old male patient with intractable post CABG pneumonia post-op 15 days in an intensive care unit. During and post-TLT courses were not eventful. The cannula was removed 2 weeks after TLT and the patient was subsequently discharged to ward.
Aged ; Catheters ; Heart* ; Humans ; Intensive Care Units ; Intubation, Intratracheal ; Male ; Pneumonia ; Respiration, Artificial ; Thoracic Surgery* ; Tracheostomy* ; Ventilator Weaning

Airway management is important during general anesthesia. Difficulties with a direct laryngoscopy can be managed successfully in a routine manner using a laryngeal mask airway. A 65-year-old woman was scheduled to undergo gynecologic surgery. After injecting the intravenous induction agents and muscle relaxants, intubation was attempted with a direct laryngoscope. However, the vocal cords could not be observed with only the epiglottis being slightly visible. Although intubation was re-attempted by another anesthesiologist, it failed. Intubation was successfully performed via an intubating laryngeal mask airway (ILMA) after additional 100% oxygen mask ventilation. We report a case of vocal cord palsy subsequent to tracheal extubation after endotracheal intubation via ILMA.
Aged ; Airway Extubation ; Airway Management ; Anesthesia, General ; Epiglottis ; Female ; Gynecologic Surgical Procedures ; Hoarseness ; Humans ; Intubation ; Intubation, Intratracheal ; Laryngeal Masks ; Laryngoscopes ; Laryngoscopy ; Masks ; Muscles ; Oxygen ; Ventilation ; Vocal Cord Paralysis ; Vocal Cords