Low Pressure Low Frequency Jet Ventilation: Techniques, Safety and Complications

Objective: Manual jet ventilation is a specialized oxygenation and ventilation technique that is not available in all facilities due to lack of technical familiarity and fear of complications. The objective is to review our center’s 15 year experience with low pressure low frequency jet ventilation (LPLFJV). Methods: Retrospective review of procedures utilizing LPLFJV from 2005 to 2019 were performed collecting patient demographic, surgery type and complications. Fisher exact test, Chi square, and t-test were used to determine statistical significance. Results: Four hundred fifty-seven patients underwent a total of 891 microlaryngeal surgeries—279 cases for voice disorders, 179 for lesions, and 433 for airway stenosis. The peak jet pressure for all cases did not exceed 20 psi and average peak pressure for the last 100 procedures in this case series was 14.9 ± 4.6 psi. The average lowest oxygen saturation for all cases was 95% ± 0.6%. Brief intubation was required in 154 cases (17%). Surgical duration was significantly longer for cases requiring intubation P < .001. The need for intubation was not associated with smoking or cardiopulmonary disease, but was strongly associated with body mass index (BMI). Intubation rates were 7% for normal weight (BMI < 25, N = 216), 13% for overweight (BMI 25-30, N = 282), 24% for obese (BMI 30-40, N = 342), and 37% for morbidly obese (BMI > 40, N = 52) patients. Three patients developed respiratory distress in the recovery unit and 2 patients required intubation. Conclusion: LPLFJV assisted by intermittent endotracheal intubation is an exceedingly safe and effective intraoperative oxygenation and ventilationmodality for a broad variety of laryngeal procedure.

Numerical Description of Jet and Duct Ventilation in Underground Garage after LPG Dispersion

Contamination of toxic and odorous gases emitted from stacks in buildings located in an urban environment are potential health hazards to citizens. A simulation using the computational fluid dynamic technique may provide detailed data on the flammable region and spatial dispersion of released gases. Concentrations or emissions associated with garage sources and garage-to-house migration rates are needed to estimate potential exposures and risk levels. Therefore, the aim of the study was to use an original mathematical model to predict the most accurate locations for LPG sensors in an underground garage for vehicles powered with LPG. First, the three-dimensional geometry of an underground garage under a multi-family building was reconstructed. Next, two types of ventilation, jet and duct, were considered, and different sources of LPG leakage were assumed. Then, the Ansys Fluent software was applied as a solver, and the same initial value of released LPG (5 kg) was assumed. As a simplification, and to avoid the simulation of choked outflow, the emission from a large area was adopted. The results showed stagnation areas for duct ventilation in which gas remained for both the jet and duct ventilation. Moreover, it was observed that the analyzed gas would gather in the depressions of the ground in the underground garage, for example in drain grates, which may create a hazardous zone for the users of the facility. Additionally, it was observed that for jet ventilation, turbulence appearance sometimes generated differentiated gas in an undesirable direction. The simulation also showed that for blowing ventilation around the garage, and for higher LPG leakage, a higher cloud of gas that increased probability of ignition and LPG explosion was formed. Meanwhile, for jet ventilation, a very low concentration of LPG in the garage was noticed. After 35 s, LPG concentration was lower than the upper explosive limit. Therefore, during the LPG leakage in an underground garage, jet ventilation was more efficient in decreasing LPG gas to the non-explosive values.

CFD Study on the Ventilation Effectiveness in a Public Toilet under Three Ventilation Methods

The indoor air quality (IAQ) of severely polluted toilets is associated with the transmission of diseases. Computational fluid dynamics (CFD) methods and experimental measurements were used to analyze the diffusion characteristics of pollutants. This study investigated the diffusion characteristics and normalized concentration of ammonia and hydrogen sulfide pollutants under three ventilation systems—mixing ventilation (MV), personalized ventilation (PV), and impinging jet ventilation (IJV)—in a public toilet. The mean age of air (MAA) and air exchange efficiency (AEE) were also analyzed in our study. The results show that the MV scheme has a poor removal effect on pollutants compared with PV and IJV. IJV has advantages in reducing the normalized concentration of pollutants and improving the IAQ. Increasing the number of air changes per hour (ACH) may lead to a longer MAA and reduced air exchange efficiency. Choosing an appropriate number of air changes is very important to improve the IAQ in the toilet.

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

<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.

Ear, nose and throat surgery

This chapter discusses the anaesthetic management of ear, nose and throat (ENT) surgery (otolaryngological surgery). It begins with a discussion of relevant general principles (including the shared airway), and covers airway obstruction and jet ventilation. Surgical procedures covered include grommet insertion; tonsillectomy; adenoidectomy; myringoplasty; stapedectomy; tympanoplasty; nasal cavity surgery; microlaryngoscopy; tracheostomy; laryngectomy; radical neck dissection, and parotidectomy. It includes pertinent anaesthetic features for a series of additional miscellaneous ENT procedures.

On-site measurement and numerical investigation of thermal environment with different air distribution systems in ice arenas

It is important to strictly maintain the indoor thermal environment in ice arenas which have very different features to other commercial buildings. Separated air distribution system is widely used to create a dry and cold environment near the ice and a comfortable environment in the view stand. The warm and humid air from the view stand may lead to uneven temperature and humidity distribution in the rink, leading to extra energy consumption, even fog and frost on the ice. Unreasonable air supply in the ice rink zone will also make the spectators feel too cold and uncomfortable. Jet ventilation system is the most extensively used system in the ice rink zone. An innovative ground displacement ventilation system is proposed in the National Aquatics Centre, which will serve as the venue for the curling competition in the 2022 Beijing Winter Olympics. On-site measurement in the arena is carried out and computational fluid dynamics (CFD) simulation method is adopted in the present research. Measured thermal environment above the ice with different ventilation systems are compared and analysed. Result shows that the displacement ventilation system features a more obvious vertical stratification than jet ventilation system in this kind of large space buildings, and thus is more energy-efficient. A CFD model of the ice cube is setup and verified by measured data. The thermal environment in the ice rink with displacement ventilation under extreme condition is studied using the simulation method. The temperature and humidity in the ice field increases by 10.1 °C, 4.5 g/kg without air supply in the view stand, proving that the spectators in the view stand have a great impact on the thermal environment in the ice field.