Impact of Ventilation Modes on Bronchoscopic Chartis Assessment Outcome in Candidates for Endobronchial Valve Treatment

Respiration ◽  
2021 ◽  
pp. 1-9
Author(s):  
Jacopo Saccomanno ◽  
Christoph Ruwwe-Glösenkamp ◽  
Konrad Neumann ◽  
Felix Doellinger ◽  
Pavlina Lenga ◽  
...  
Keyword(s):  
Spontaneous Breathing ◽  
Conclusive Evidence ◽  
Assessment System ◽  
Low Flow ◽  
Jet Ventilation ◽  
Characteristic Analysis ◽  
Lung Emphysema ◽  
Endobronchial Valve ◽  
Ventilation Modes ◽  
Redwood City

<b><i>Background:</i></b> Endobronchial valve therapy has proven to reduce lung hyperinflation and decrease disease burden in patients with severe lung emphysema. Exclusion of collateral ventilation (CV) of the targeted lobe by using an endobronchial assessment system (Chartis; PulmonX, Drive Redwood City, CA, USA) in combination with software-based fissure integrity analysis (FCS [fissure completeness score]) of computed tomography scans of the lung are established tools to select appropriate patients for endobronchial valve treatment. So far, there is no conclusive evidence if the ventilation mode during bronchoscopy impacts the outcome of Chartis assessments. <b><i>Methods:</i></b> Patients with Chartis assessments and software-based quantification of FCS (StratX; PulmonX, Drive Redwood City, CA, USA) were enrolled in this retrospective study. During bronchoscopy, pulmonary fissure integrity was evaluated with the Chartis assessment system in each patient first under spontaneous breathing and subsequently under high-frequency (HF) jet ventilation. <b><i>Results:</i></b> In total, 102 patients were analyzed. Four Chartis phenotypes CV positive (CV+), CV negative (CV−), low flow, and low plateau in spontaneous breathing and HF jet ventilation were identified. The frequency of each Chartis phenotype per lobe was similar in both settings. When comparing Chartis assessments in spontaneous breathing and HF jet ventilation, there was an overall good concordance rate for all analyzed fissures. In agreement, receiver operating characteristic analysis of the FCS showed an almost similar prediction for CV+ and CV− status independent of the ventilation modes. <b><i>Conclusion:</i></b> Chartis assessment in spontaneous breathing and HF jet ventilation had similar rates in detecting CV in lung emphysema. Our results suggest that both modes are equivalent for the assessment of CV.

scholarly journals Collapse phenomenon during Chartis collateral ventilation assessment

2016 ◽  
Vol 47 (6) ◽  
pp. 1657-1667 ◽  
Author(s):  
Wolfgang Gesierich ◽  
Konstantinos Samitas ◽  
Frank Reichenberger ◽  
Juergen Behr
Keyword(s):  
Computed Tomography ◽  
High Resolution ◽  
Predictive Value ◽  
Spontaneous Breathing ◽  
Prognostic Value ◽  
Jet Ventilation ◽  
High Resolution Computed Tomography ◽  
Airway Collapse ◽  
Endobronchial Valve ◽  
Collateral Ventilation

Chartis is increasingly used for bronchoscopic assessment of collateral ventilation before endobronchial valve (EBV) treatment for severe emphysema. Its prognostic value is, however, limited by the airway collapse phenomenon. The frequency and clinical significance of the collapse phenomenon remain largely unknown.We performed a retrospective analysis of 92 patients undergoing Chartis evaluation under spontaneous breathing (n=55) or jet ventilation (n=37) from May 2010 to November 2013. Collateral ventilation status (positive/negative/collapse phenomenon/unclear) was reassessed and correlated with high-resolution computed tomography (HRCT) fissure analysis and clinical response.In the absence of the collapse phenomenon, the predictive value of Chartis measurements and HRCT fissural analysis was comparable. The collapse phenomenon was observed in 31.5% of all assessments, and was more frequent in lower lobes (44.9% versus 16.9% in upper lobes) and under jet ventilation (41.4% versus 22.1% under spontaneous breathing). 69.8% of lobes with the collapse phenomenon had complete fissures. Most patients with the collapse phenomenon in the target lobe and complete fissures treated with EBVs were responders (n=11/15). All valve-treated collapse phenomenon patients with fissure defects were nonresponders (n=3).In the absence of the collapse phenomenon Chartis measurement is reliable to predict response to valve treatment. In patients with the collapse phenomenon, treatment decisions should be based on HRCT detection of fissure integrity. Chartis assessment should be performed under spontaneous breathing.

Suppression of spontaneous breathing during high-frequency jet ventilation

1986 ◽  
Vol 12 (1) ◽  
pp. 26-32 ◽  
Author(s):  
A. J. van Vught ◽  
A. Versprille ◽  
J. R. C. Jansen
Keyword(s):  
High Frequency ◽  
Spontaneous Breathing ◽  
Jet Ventilation ◽  
High Frequency Jet Ventilation

scholarly journals Mechanical respiratory support for COVID-19: lessons from 2020

2021 ◽  
Vol 8 (1) ◽  
pp. 19-37
Author(s):  
V. A. Mazurok
Keyword(s):  
Mechanical Ventilation ◽  
Spontaneous Breathing ◽  
Intensive Therapy ◽  
Invasive Mechanical Ventilation ◽  
Respiratory Support ◽  
Low Flow ◽  
Death Sentence ◽  
Technical Equipment ◽  
Unsuccessful Attempt ◽  
Wide Range

Intensive therapy of out-of-hospital pneumonia in conditions of mass admission of patients during 2020 presented many lessons, including regarding the strategy of respiratory support, as it turned out that mechanical ventilation in passive patients with COVID-19 is almost equivalent to a death sentence. On the other hand, maintaining spontaneous breathing in dyspnea and hyperpnea conditions can cause specific self-inflicted lung injuryUnexpectedly, the good tolerability of hypoxemia by patients has led to the emergence of the terms “happy hypoxia” and “permissive hypoxemia,” reflecting the effective functioning of acute adaptation mechanisms: increasing heart productivity and oxygen utilization.A step-by-step strategy for respiratory therapy was formed: 1) oxygen therapy (low-flow, high-flow), 2) non-invasive respiratory support (NIV), 3) controlled lung ventilation. Among the most effective resources for mobilizing alveoli in patients with COVID-19 was the prone position.Compared to a tight mask, the helmet turned out to be the most effective method of conducting NIV. When using the helmet, bedsores on the face and the bridge of the nose do not develop, enteral nutrition is possible, subjective tolerability of NIV by patients is increased.Conversion to invasive mechanical ventilation is considered in case of energy inadmissibility of spontaneous breathing and development of central nervous system disorders. Breathing equipment with a wide range of ventilation modes and expert capabilities for respiratory monitoring is needed to carry out both mechanical ventilation and especially NIV.If pulmonary gas exchange is not possible, the only means of saving the patient remains extracorporeal membrane oxygenation — a method that requires huge energy costs from trained medical personnel and good technical equipment of the clinic.One of the most visible lessons presented by the pandemic of viral pneumonia is the unsuccessful attempt to speed up the training of “intensive care specialists” through on-line courses, webinars and even guide sheets.

scholarly journals Setting of High-Flow Nasal Oxygen Post Extubation based on Inspiratory Flow during a Spontaneous Breathing Trial

2020 ◽  
Author(s):  
Sophia Butt ◽  
Laura Pistidda ◽  
Leda Floris ◽  
Corrado Liperi ◽  
Francesco Vasques ◽  
...  
Keyword(s):  
Flow Rate ◽  
Spontaneous Breathing ◽  
Work Of Breathing ◽  
Spontaneous Breathing Trial ◽  
Inspiratory Flow ◽  
High Flow ◽  
Low Flow ◽  
Beneficial Effects ◽  
Standard Clinical Practice ◽  
Fraction Of Inspired Oxygen

Abstract Background: High flow nasal cannula (HFNC) is commonly used post-extubation in intensive care (ICU). Patients’ comfort during HFNC is affected by flow rate: too low flow may limit the beneficial effects of HFNC on gas exchange and work of breathing; whilst excessive flow may reduce comfort and adherence to therapy. Currently, there is no consensus on how to set the flow rate of HFNC post-extubation. The study aims to describe the relationship between pre-extubation inspiratory flow requirements and the post-extubation flow rates on HFNC that maximises patient’s level of comfort.Methods: This was an observational, retrospective, single-site study conducted in a tertiary, university-affiliated ICU. We included all patients extubated following a successful, standardised spontaneous breathing trial (SBT) during a four-month study period. During a 30-minute SBT we recorded haemodynamic and respiratory variables including inspiratory flow, presence of any signs of respiratory distress and level of comfort using a visual analogue scale (VAS). Patients who passed the SBT were extubated onto HFNC – as per standard clinical practice. HFNC was titrated starting from a flow of 20 L/min and increased in steps of 10L/min, up to 60 L/min or maximum tolerated flow. At each step, patient’s level of comfort was assessed using a VAS. Fraction of inspired oxygen (FiO2) was titrated to maintain oxygen saturation measured by pulse oximetry (SpO2) 92-97%. Results: Nineteen participants were enrolled in the study with a mean (SD) age of 62.5 ± 13.1 years. There was a significant positive correlation between mean inspiratory flow pre-extubation and the flow setting on HFNC which achieved the best comfort post-extubation (r2 0.88; p <0.001). The greatest comfort was observed for HFNC flows between 30 and 40 L/min, while above 40 L/min patients’ comfort decreased. Conclusions: Measuring mean inspiratory flow during an SBT allows for individualised setting of HFNC flow rate immediately post-extubation and achieves the greatest comfort and interface tolerance.

Suppression of spontaneous breathing during high-frequency jet ventilation

1987 ◽  
Vol 13 (5) ◽  
pp. 315-322 ◽  
Author(s):  
A. J. van Vught ◽  
A. Versprille ◽  
J. R. C. Jansen
Keyword(s):  
High Frequency ◽  
Spontaneous Breathing ◽  
Jet Ventilation ◽  
High Frequency Jet Ventilation

Transtracheal jet ventilation in a general tertiary hospital: A 7-year audit

2021 ◽  
pp. 0310057X2110025
Author(s):  
Richard K Barnes ◽  
Jonathan Au
Keyword(s):  
Airway Management ◽  
Tertiary Hospital ◽  
High Rate ◽  
Low Flow ◽  
Jet Ventilation ◽  
Retrospective Audit ◽  
Tertiary Hospitals ◽  
Tertiary Healthcare ◽  
Alternative Means ◽  
Rate Of Success

Airway management in patients presenting with severe airway obstruction can present a challenge to the anaesthetist, as conventional difficult airway pathways are often inappropriate. The use of a transtracheal jet cannula is an alternative means of airway securement, but lack of familiarity has limited its use in general tertiary hospitals. We report a retrospective audit of the use of transtracheal jet ventilation in a general tertiary healthcare centre over the past seven years, with a total of 50 patients with severe airway compromise undergoing pharyngolaryngeal surgery. Transtracheal jet ventilation was successful in 98% of patients, and was the definitive means of airway management in 43 cases. In six cases, the technique was a useful temporising measure while the airway was secured by other means. Minor complications occurred in 12% of patients. No major morbidities or mortalities were recorded. We conclude that transtracheal jet ventilation for high-risk pharyngolaryngeal surgery can be performed using a high frequency jet ventilator, with a high rate of success and only minor complications. Cannulation of the trachea below the cricothyroid membrane is feasible but more challenging. Low-flow apnoeic oxygenation through the transtracheal jet ventilation cannula maintains oxygenation during initial surgical airway manipulation.

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