摘要:

Nine ventilator-dependent patients were successfully weaned from mechanical ventilatory support by high-frequency jet ventilation. All patients had been on ventilatory support for at least 2 wk, and had not responded to attempts at weaning by intermittent mandatory ventilation.

ISSN:0090-3493    

出版商:OVID    

年代:1984

数据来源: OVID

摘要:

One hundred patients were ventilated with high-frequency jet ventilation (HFJV) during the initial 24-h postoperative period in the surgical and neurosurgical ICUs. Eighty-three were successfully weaned, 2 could not be ventilated adequately with HFJV, and 15 with criteria of acute respiratory failure received HFJV for up to 21 days. A HFJV delivery system consisted of jetting and entrainment systems, both with their own humidification designs. An initial mode of HFJV using 35 psi, jet rate 100 cycle/min and inspiratory time 30% provided a mean Paco2of 34 torr in 38 patients studied. A comparison of HFJV without and with a positive end-expiratory pressure (PEEP) of 10 cm H2O indicated a decrease in mean Qsp/Qt from 17% to 13% with decrease in cardiac index (CI) from 3.39 to 2.81 L/min·m2; this effect is similar to PEEP applied to a conventional ventilator. Weaning proved to be simple and comfortable for the patient. In the light of our experience, we believe that HFJV is both feasible and practical for the postoperative patient and should be introduced into routine clinical use.

ISSN:0090-3493    

出版商:OVID    

年代:1984

数据来源: OVID

摘要:

Airway pressures and cardiorespiratory variables were compared for conventional ventilation (CV) and high-frequency jet ventilation (HFJV), at a similar fraction of inspired O2(Fio2), positive end-expiratory pressure (PEEP) and Paco2in 11 ICU patients. For CV and HFJV, respectively, peak (PAP) and mean airway pressures (Paw) were 15.4 and 9.1 mm Hg and 4.4 and 5 mm Hg. Cardiac index (CI) was 2.54 and 2.60 L/min·m2, total systemic vascular resistance index (SVRI) 2846 and 2923 dynesec/cm5·m2, Pao2207 and 149 torr, and Qsp/Qt 7% and 11%. HFJV decreased significantly PAP and was less likely to produce pulmonary barotrauma. Cardiac indices were not different, indicating that this variable may be affected by Paw. HFJV neither increased nor decreased CI at similar PEEP and Paco2as compared to CV. The decrease in Pao2and increase in Qsp/Qt may be due to small inspired gas volumes potentiating microatelectasis. On the basis of this study, we recommend initiating HFJV at Fio2of 0.9 and PEEP of 5 cm H2O, and monitoring both PAP and Paw.

ISSN:0090-3493    

出版商:OVID    

年代:1984

数据来源: OVID

摘要:

Oxygenation and ventilation were assessed in 15 post-operative patients before, immediately after, and 3 min after 15 sec of tracheobronchial suctioning in the presence or in the absence of high-frequency jet ventilation (HFJV). When HFJV was continued during suctioning, the mean Pao2decrease was only 15 ± 9 torr, compared to a 90 ± 16 torr decrease when HFJV was discontinued. This difference demonstrates that continuation of HFJV during tracheobronchial suctioning prevents a decrease in Pao2.

ISSN:0090-3493    

出版商:OVID    

年代:1984

数据来源: OVID

摘要:

Twenty-five newborn infants with severe respiratory failure responding poorly to conventional mechanical ventilation were switched to high-frequency positive-pressure ventilation (HFPPV) at 90 to 180 cycle/min (mean 158), an estimated tidal volume less than or equal to 3 ml/kg body weight, an inspiratory time of 0.1 sec, and a PEEP of 3 to 17 cm H2O. In all infants, HFPPV increased Pao2(mean 66 torr) and decreased Paco2(mean 14 torr) within 1 h. Fourteen hours after onset of treatment, the Fio2requirement had decreased from 1.0 to 0.6 in all infants. Mean airway pressure (Paw) with HFPPV was usually less than or equal to Paw during conventional ventilation. In spite of the often high level of PEEP used, pneumothorax occurred in only 2 infants and bronchopulmonary dysplasia in 1. Eighteen (72%) infants survived and none died of respiratory failure. The use of HFPPV might be beneficial in neonates with severe respiratory failure that responds poorly to conventional therapy.

ISSN:0090-3493    

出版商:OVID    

年代:1984

数据来源: OVID

摘要:

As the treatment of respiratory failure becomes more sophisticated and technical, the critical care nurse is faced with many challenges. High-frequency ventilation is a modality of respiratory support employing principles different from those of conventional ventilation. For these reasons, the nurse must be familiar with the indications for its use and the practical management of the ventilated patient. This paper addresses those aspects of respiratory support which have the greatest impact on nursing care.

ISSN:0090-3493    

出版商:OVID    

年代:1984

数据来源: OVID

摘要:

High-frequency pulsation (HFP), a modified highfrequency jet ventilation (HFJV) technique, was applied intraoperatively as an alternative to conventional inter mittent positive-pressure ventilation in 16 patients undergoing major thoracic operations. Gas exchange and hemodynamic stability were maintained at a frequency of 300 cycle/min. Surgical maneuvers were easier because the lungs were almost completely immobilized.

ISSN:0090-3493    

出版商:OVID    

年代:1984

数据来源: OVID

摘要:

Peroral endoscopies and elective or emergency surgery must often be performed in the airway of patients in poor physical condition. This retrospective review of 600 patients undergoing various surgical procedures found that 194 were ASA physical status groups III or IV, with various abnormalities affecting the cardiorespiratory or central and peripheral nervous systems. These patients received iv anesthesia using short-acting drugs, to guarantee rapid postoperative recovery. All were intraoperatively ventilated with either high-frequency positive-pressure ventilation or high-frequency jet ventilation. Both techniques proved effective, even in patients with upper airway obstruction. In combination with CO2laser removal of tumors of the glottic region, high-frequency ventilation may prevent the need for emergency tracheotomies.

ISSN:0090-3493    

出版商:OVID    

年代:1984

数据来源: OVID

摘要:

Criteria for selection of high-frequency ventilators, and in particular high-frequency jet ventilators are not significantly different from those for conventional mechanical ventilators. Selection is based upon the design principles and performance characteristics of the ventilator and successful clinical applications that establish clearly its safety and efficacy. The final choice is also influenced by the physical status of the patient, potential physiologic advantages and disadvantages, the necessary requirements of the clinical situation, and the capability of providing adequate oxygenation and ventilation.

ISSN:0090-3493    

出版商:OVID    

年代:1984

数据来源: OVID

摘要:

A conventional, low-frequency ventilator was modified to ventilate dogs at high frequencies of 85 to 185 cycle/min while cardiovascular and pulmonary variables were monitored. Although gas transport was adequate, cardiac output was diminished when compared to lowfrequency ventilation. The addition of an in-line pneumotachograph markedly increased PaCO2during highfrequency ventilation. Carbon dioxide transport was primarily dependent upon the magnitude of the tidal volume at all high frequencies tested.

ISSN:0090-3493    

出版商:OVID    

年代:1984

数据来源: OVID