High-frequency jet ventilation during radiofrequency ablation: a case report.

High-frequency jet ventilation (HFJV) has been used in emergency airway scenarios and various surgical procedures. Although substantial literature is available regarding HFJV in these situations, there is only 1 publication to date concerning its use for cardiac radiofrequency ablation procedures. The following case study describes a 49-year-old man undergoing radiofrequency ablation in which HFJV was used. This method has been used for these procedures for months in our institution with great success. Its effectiveness is attributed to the lack of significant heart movement as compared with conventional intermittent positive-pressure ventilation, which, in turn, has improved surgical conditions and resulted in decreased procedure times. In this case, a newly introduced in-line circuit filter was used. Impedance to passive exhalation was created after the filter became saturated from the high humidification. This event, its management, and the following discussion on the mechanics of HFJV and its use in radiofrequency ablation procedures make this case an educational value to all anesthesia providers.

Ground transport of an infant on high-frequency jet ventilation: a case presentation.

High-frequency jet ventilation (HFJV) was developed to meet the need for adequate ventilation while avoiding the adverse consequences of conventional mechanical ventilation (CMV). HFJV can be beneficial to infants who have failed CMV. Some infants may need the additional support of extracorporeal membrane oxygenation (ECMO). To be optimally transported to a center that offers this treatment, the infant may need to be ventilated using HFJV. For the transport team, delivery of the infant to the receiving hospital in optimal condition is the goal. The challenges of overcoming the environmental hindrances inherent in transport combine with the challenge of caring for an acutely and critically ill infant. When the infant is transported on HFJV, these challenges are magnified. This article briefly discusses HFJV and examines the preparations and equipment required for transport, as well as special considerations for managing the infant on HFJV during transport.

AANA journal course: update for nurse anesthetists--beyond the laryngoscope: advanced techniques for difficult airway management.

Airway catastrophes have been identified as the leading cause of injury and death during anesthesia. Proper management of a patient with a technically difficult airway commences with problem recognition. Physical limitations to mask ventilation and endotracheal intubation may be accurately identified by thorough observation. All patients should be examined for oral structure visibility, size of mandibular space, and ability to assume "sniffing" position. Patients with compromised airways should have patency secured while remaining awake by direct laryngoscopy, nasotracheal intubation, fiberoptic endoscopy, retrograde intubation, or possibly tracheostomy. Partial or complete airway obstruction requires immediate recognition and intervention. Repeated, unsuccessful attempts at endotracheal intubation should be avoided, as these may lead to laryngeal edema or hemorrhage which may critically compromise airway maintenance. Prudent options may include awakening the patient, proceeding with mask ventilation, or performing semi-elective tracheostomy. Emergency airway access may be achieved with a tracheoesophageal airway, esophageal tracheal combitube, laryngeal mask airway, digital intubation, or obtained surgically by transtracheal jet ventilation or tracheostomy. Reduction of airway-related morbidity and mortality is best achieved with an understanding of airway anatomy, common causes and prompt recognition of compromise, and alternative techniques of establishing patency and ventilation.

Nursing care of the neonate receiving high-frequency jet ventilation.

Respiratory distress remains a major source of morbidity and mortality among infants, despite advances in conventional mechanical ventilation over the past 20 years. High-frequency jet ventilation provides an alternative treatment modality for neonates suffering from pulmonary air leak syndromes, such as pulmonary interstitial emphysema and pneumothorax. This new technology presents special challenges to the nurse caring for these critically ill neonates and their families.

Alternate modes of mechanical ventilation.

As a result of technological progress and a better understanding of respiratory disease processes, new modes of mechanical ventilation for the critically ill patient have been developed. These new methods may offer specific advantages over traditional techniques by avoiding or reducing complications commonly associated with positive pressure ventilation. A thorough understanding of anticipated benefits and potential problems is carefully considered for each mode of mechanical ventilation. Several alternate approaches to ventilatory assistance are discussed. Clinical applications of nursing care are also discussed.

High-frequency ventilation and extracorporeal membrane oxygenation.

Dramatic improvement in morbidity and mortality associated with neonatal respiratory failure has evolved over the last 30 years. Favorable survival statistics can be directly related to the institution and refinement of assisted ventilation techniques. Short- and long-term pulmonary complications continue to be of major concern. New ways to support the neonate in respiratory failure are being investigated. Concentrated efforts are being undertaken to find ways to safely and effectively treat these infants while decreasing the morbidity associated with therapy. Two such therapies, both experimental and controversial, which are gaining widespread recognition, are high-frequency ventilation (HFV) and extracorporeal membrane oxygenation (ECMO).

High-frequency jet ventilation for severe respiratory failure.

High-frequency jet ventilation (HFJV) is a newer form of mechanical ventilatory support that has shown promise in the treatment of severe neonatal respiratory distress syndrome. It is now also being studied as a possible treatment for adult respiratory distress syndrome in older children.