Effectiveness of high-frequency jet ventilation in management of an experimental bronchopleural fistula. 1982

M Barringer, and J Meredith, and D Prough, and R Gibson, and R Blinkhorn

An animal model was prepared to compare the effectiveness of high-frequency jet ventilation (HFJV) with that of conventional intermittent positive pressure ventilation (IPPV) in managing bronchopleural fistula. In ten adult beagles, the left upper pulmonary lobe was resected and the left upper lobe bronchus was cannulated to establish a permanent bronchopleural fistula. Apposition of the middle lobe to the chest wall was examined via an open thoracotomy. Fistula leakage was measured with the thoracotomy closed, and chest tube drainage was set at 20 cm H2O. With HFJV, lung apposition was attained at lower peak (8.9 cm H2O) and expiratory (5.7 cm H2O) pressures than with IPPV (21.2 cm H2O Peak pressure and 10.7 cm H2O expiratory pressure). With equivalent arterial blood gases, fistula leakage was 47 per cent higher with IPPV than with HFJV (P less than .001). Each 5 cm of positive end expiratory pressure (PEEP) added increased fistula leakage similarly to both systems. Varying the frequency of HFJV did not alter leakage significantly, but increasing the driving pressure markedly increased leakage. Thus, experimentally, HFJV proved superior to IPPV in the management of bronchopleural fistula. When HFJV is used clinically to manage a bronchopleural fistula, the driving pressure should be kept as low as possible and PEEP should be limited. The ventilatory rate may be varied to achieve the desired PaCO2 without significantly affecting leakage through the fistula.

UI MeSH Term Description Entries
D007385 Intermittent Positive-Pressure Ventilation Application of positive pressure to the inspiratory phase when the patient has an artificial airway in place and is connected to a ventilator. BIPAP Biphasic Intermittent Positive Airway Pressure,IPPV,Inspiratory Positive-Pressure Ventilation,Ventilation, Intermittent Positive-Pressure,Biphasic Intermittent Positive Airway Pressure,Inspiratory Positive Pressure Ventilation,Intermittent Positive Pressure Ventilation,Positive-Pressure Ventilation, Inspiratory,Positive-Pressure Ventilation, Intermittent,Ventilation, Inspiratory Positive-Pressure,Ventilation, Intermittent Positive Pressure
D010995 Pleural Diseases Diseases involving the PLEURA. Disease, Pleural,Diseases, Pleural,Pleural Disease
D011312 Pressure A type of stress exerted uniformly in all directions. Its measure is the force exerted per unit area. (McGraw-Hill Dictionary of Scientific and Technical Terms, 6th ed) Pressures
D012121 Respiration, Artificial Any method of artificial breathing that employs mechanical or non-mechanical means to force the air into and out of the lungs. Artificial respiration or ventilation is used in individuals who have stopped breathing or have RESPIRATORY INSUFFICIENCY to increase their intake of oxygen (O2) and excretion of carbon dioxide (CO2). Ventilation, Mechanical,Mechanical Ventilation,Artificial Respiration,Artificial Respirations,Mechanical Ventilations,Respirations, Artificial,Ventilations, Mechanical
D012129 Respiratory Function Tests Measurement of the various processes involved in the act of respiration: inspiration, expiration, oxygen and carbon dioxide exchange, lung volume and compliance, etc. Lung Function Tests,Pulmonary Function Tests,Function Test, Pulmonary,Function Tests, Pulmonary,Pulmonary Function Test,Test, Pulmonary Function,Tests, Pulmonary Function,Function Test, Lung,Function Test, Respiratory,Function Tests, Lung,Function Tests, Respiratory,Lung Function Test,Respiratory Function Test,Test, Lung Function,Test, Respiratory Function,Tests, Lung Function,Tests, Respiratory Function
D001980 Bronchi The larger air passages of the lungs arising from the terminal bifurcation of the TRACHEA. They include the largest two primary bronchi which branch out into secondary bronchi, and tertiary bronchi which extend into BRONCHIOLES and PULMONARY ALVEOLI. Primary Bronchi,Primary Bronchus,Secondary Bronchi,Secondary Bronchus,Tertiary Bronchi,Tertiary Bronchus,Bronchi, Primary,Bronchi, Secondary,Bronchi, Tertiary,Bronchus,Bronchus, Primary,Bronchus, Secondary,Bronchus, Tertiary
D001983 Bronchial Fistula An abnormal passage or communication between a bronchus and another part of the body. Bronchial Fistulas,Fistula, Bronchial,Fistulas, Bronchial
D004195 Disease Models, Animal Naturally-occurring or experimentally-induced animal diseases with pathological processes analogous to human diseases. Animal Disease Model,Animal Disease Models,Disease Model, Animal
D004285 Dogs The domestic dog, Canis familiaris, comprising about 400 breeds, of the carnivore family CANIDAE. They are worldwide in distribution and live in association with people. (Walker's Mammals of the World, 5th ed, p1065) Canis familiaris,Dog
D004322 Drainage The removal of fluids or discharges from the body, such as from a wound, sore, or cavity.

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