High frequency jet ventilation through a supraglottic airway device: a case series of patients undergoing extra-corporeal shock wave lithotripsy

Embolisation of pulmonary arteriovenous malformations using high-frequency jet ventilation: benefits of minimising respiratory motion

Background

To evaluate patient radiation dose and procedural duration recorded during pulmonary arteriovenous malformation (PAVM) embolisation performed using high-frequency jet ventilation (HFJV) as compared with conventional intermittent positive pressure ventilation (IPPV)

Methods

Patients undergoing PAVM embolisation with HFJV assistance after April 2017 were retrospectively identified as group A, and those treated with IPPV before April 2017 as group B. Primary outcomes were patient radiation dose and procedural duration between groups A and B. Secondary outcomes were difference in diaphragmatic excursion between groups A and B, in group A with/without HFJ assistance, technical/clinical success, and complications.

Results

Twelve PAVMs were embolised in 5 patients from group A, and 15 PAVMs in 10 patients from group B. Mean patient radiation was significantly lower in group A than in group B (54,307 ± 33,823 mGy cm² [mean ± standard deviation] versus 100,704 ± 43,930 mGy cm²; p = 0.022). Procedural duration was 33.4 ± 16.1 min in group A versus 57.4 ± 14.9 min in group B (p = 0.062). Diaphragmatic excursion was significantly lower in group A (1.3 ± 0.4 mm) than in group B (19.7 ± 5.2 mm; p < 0.001) and lower with near statistical significance in group A with HFJV than without HFJV (1.3 ± 0.4 mm versus 10.9 ± 3.1 mm; p = 0.062). Technical and clinical success was 100% in both groups, without relevant complications.

Conclusion

HFJV-assisted PAVM embolisation is a safe, feasible technique resulting in reduced patient radiation doses and procedural time.

The Veres adapter: clinical experience with a new device for jet ventilation via a laryngeal mask airway during flexible bronchoscopy

BACKGROUND

A new device was developed to deliver high-frequency jet ventilation via a laryngeal mask airway (LMA). We investigated its use during flexible fiberoptic bronchoscopy in anesthetized patients.

METHODS

Thirty adults were studied during interventional bronchoscopy. After facemask ventilation, the Veres adapter was connected to a size 4 or 5 LMA, and superimposed high-frequency jet ventilation was performed. Oxygen saturation, transcutaneous carbon dioxide, supraglottic airway pressure, and hemodynamic data were recorded and analyzed.

RESULTS

Procedures were performed under stable hemodynamic conditions. Short procedure times and fast recovery were observed. Mild hypercapnia was the most common minor adverse effect (n = 16). One patient developed a pneumothorax after peripheral biopsy, 1 patient had a stiff chest during bronchoscopy, resulting in high airway pressures, and 1 patient required continuous positive airway pressure mask ventilation in the postoperative care unit.

CONCLUSIONS

We report the clinical use of the Veres adapter in conjunction with an LMA to achieve rapid surgical access and adequate ventilation during flexible bronchoscopy. As an alternative to the use of an endotracheal tube, the new system may better maintain the airway during interventional and diagnostic bronchoscopy because of the larger diameter conduit.