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Objective: Single-frequency high-frequency jet ventilation (HFJV) is an established ventilatory technique during laryngotracheal surgery. This study describes the clinical use of combined HFJV, characterised by the simultaneous application of a low-frequent (LF) and a high-frequent (HF) jet stream. Methods: Two jet streams with different pulsatile frequency (HF approx. 10 Hz, LF 10-30 bpm) and adjustable driving pressures were applied supraglottically by means of a special jet laryngoscope in patients undergoing elective laryngotracheal surgery during total intravenous anaesthesia. HFJV was performed using a pneumatic or electronic jet respirator connected to the central gas supply. Results: 134 patients were submitted to tubeless HFJV applying the double-jet technique using the jet-laryngoscope. Duration of HFJV was ≤ 30 min in 60 patients (45%), between 30 and 60 min in 49 patients (36%), and ≥ 60 min in 25 patients (19%). Classification into 3 groups according to weight ((I < 65 kg, II = 65 - 84 kg, III ≥85 kg) using driving pressures of 1,52±0,47 bar, 1,64±0,78 bar, and 1,69±0,67 bar for the HF jet and 1,78±0,54 bar, 1,90±0,48 bar, and 2,00±0,49 bar for the NF jet demonstrated differences in paO 2 (156±45 [I] vs 126±34 [II] vs 96±18 [III] mm Hg) and paCO 2 (42±9 und 44±8 vs 48±8 mm Hg) using comparable F jet O 2 (0,6±0,2). Supraglottic pressures were 11,6±6,8, 11,5±7,0, und 12,6±7,1 cm H 2 O (I-III). No ventilator-related adverse events were observed. Conclusion: Tubeless supraglottic HFJV utilizing two jet streams with low and high frequency was effective in patients during laryngotracheal surgery. The application of two jet streams results in phasic changes of airway pressures between an inspiratory and expiratory pressure level, and facilitates application of enlarged tidal volumes. As demonstrated, oxigenation and ventilation is compromised by increased body weight. Superimposed HFJV (double-jet technique) enables the supraglottic ventilation of heavy patients and/ or in the presence of airway stenoses during laryngotracheal surgery without need to use maximum driving pressures.

Background: High-frequency jet ventilation (HFJV) is an alternative ventilatory approach in airway surgery and for facilitating gas exchange in patients with pulmonary insufficiency. We have developed a new technique of combined HFJV utilising two superimposed jet streams. In this study we describe the application of tubeless supralaryngeal HFJV during laryngotracheal laser surgery in infants and children. Methods: Tubeless combined HFJV characterised by the simultaneous supralaryngeal application of a low-frequency (LF) and a high-frequency (HF) jet stream was evaluated in a clinical study in 10 children undergoing elective laryngotracheal CO2 laser surgery. Additionally, pressure and flow characteristics were determined with the use of a paediatric test lung. HFJV was applied by means of a modified Kleinsasser laryngoscope with integrated metal injectors. In addition to pulse oximetry, monitoring of ECG, heart rate and blood pressure, supraglottic airway pressure was measured and arterial blood gases were analysed. Results: Tubeless combined HFJV was used in 10 infants and children (mean age 4.6 yr, range 2 months–10 years) undergoing 17 consecutive endoscopic procedures with CO2 laser microsurgery of the larynx or the trachea under general anaesthesia.The mean duration of supralaryngeal HFJV was 46 min (range 15–75 min). Mean driving pressures of the HF and the LF jet streams were 0.75 bar and 0.95 bar, respectively. Inspiratory oxygen ratios were in the range 0.4–1.0. HFJV resulted in mean PaO2 and PaCO2 values of 19.7 kPa and 6.1 kPa, respectively. No complications during HFJV were observed. In the test lung, combined HFJV applied with driving pressures of 0.7–1.0 bar and 0.9–1.2 bar for HF and LF jet ventilation, respectively, resulted in maximum peak and baseline distal airway pressures of 17.6 cm H2O and 5.4 cm H2O, respectively. Conclusion: The application of the combined double frequency HFJV was effective in maintaining gas exchange in the presence of laryngeal or tracheal stenoses. It provided good visibility of anatomical structures and offered space for surgical manipulation, avoiding the use of combustible material inside the larynx or trachea.

Einleitung: Die Akutphase Schwerbrandverletzter ist durch ein ausgeprägtes „capillary leak“ mit entsprechender Ödembildung gekennzeichnet. Entscheidungen über notwendige Infusionsmengen können durch das spezielle hämodynamische Monitoring mittels PiCCO geleitet[for full text, please go to the a.m. URL], 31. Jahrestagung der Deutschsprachigen Arbeitsgemeinschaft für Verbrennungsbehandlung (DAV 2013)

Einleitung: Die Sauerstofftherapie ist eine zunehmend häufig angewandte Therapie bei Patienten mit fortgeschrittenen pulmonalen Erkrankungen und wird sowohl im Krankenhaus als auch zu Hause durchgeführt. Nach den Richtlinien der Österreichischen Gesellschaft für Pneumologie ist die[for full text, please go to the a.m. URL], 31. Jahrestagung der Deutschsprachigen Arbeitsgemeinschaft für Verbrennungsbehandlung (DAV 2013)

Fragestellung: Standard der Verbrennungschirurgie ist die rasche Nekrosektomie und Eigenhautdeckung. Bei Schwerbrandverletzten (≥60% Körperoberfläche, KOF) ist die zur Verfügung stehende Menge autologer Spenderhaut jedoch limitierend. An unserer Abteilung ist die Meek-Technik[for full text, please go to the a.m. URL], 31. Jahrestagung der Deutschsprachigen Arbeitsgemeinschaft für Verbrennungsbehandlung (DAV 2013)