High frequency jet

ventilation (HFJV)
&
Non – Invasive By , Nisha
ventilation(NIV) Deeksha
Prajna
Gauthami
Grace
INTRODUCTION
TO HFJV  HFJV is a versatile, safe and effective
technique with growing indications for
elective and emergency use.
 In 1977 Klain and Smith developed a method
of HFJV that used a percutaneous
transtracheal catheter.
 HFJV offers rates of approximately 100 to 600
breaths/min with a tidal volume smaller than
anatomical dead space volume.

Nisha(191124002)
 During HFJV the ventilation gas is intermittently
administered by an injector with a high frequency into
the airway which is open to the outside. Exhalation
occurs passively in the area nearby the wall of the
airway cross-section.
 HFJV is characterised by delivery of small tidal volumes
(1-3mls/kg) from a high pressure jet at supra-
physiological frequencies (1-10Hz) followed by passive
expiration.

Nisha(191124002)
 Direct laryngoscopy
 Spontaneous ventilation, mechanical controlled
ventilation, apneic intermittent ventilation.
 To provide surgical fields undisturbed by ventilatory
movement
 For use with bronchoscopy and laryngoscopy to
Indications provide better surgical field access while maintaining
ventilation
 To reduce cardiovascular side effects associated with
intermittent positive-pressure ventilation (IPPV)
 To reduce the risk for barotrauma
 To maintain ventilation when large air leaks are
present (e.g., bronchopleural fistula)
Nisha(191124002)
 High pressure non –
collapsible oxygen tubing
Pressure hose – oxygen
Equipments source with a flow at 10 –
15 L/min
Manual jet ventilation /
trigger
 Pressure regulator ( less
than 50 psi )
Deeksha(191124008)
 COMPONENTS :
1) Injector needle – 13 gauge blunt ended stainless steel needle
connected to toggle valve by 1.5 meter length high pressure
tubing .
16 gauge needle recommended for infant
Toggle valve – controls the delivery of the gas mixture connected to
accumulator by at least 3 meter length of high pressure tubing
Techniques accumulator is the output of the regulator to allow for smoothing
of jetting pressure , necessary for adults weighing over 100 kg
 mixer – oxygen (70 % ) and nitrous oxide ( 30% ) are supplied from
central source at 50 psi and fed into mixture
 2) Injector needle is inserted into the right light channel of the
laryngoscope
3) The fibroptic light source is always placed in the light channel on
the left side of the laryngoscope .

Deeksha (191124008)
4) The hypoxic patient should receive oxygen in intermittent bursts.
Adults : jet pressure starting at 20 psi , increased gradually until adequate
chest rise and fall is noted, < 50 psi
Children : jet pressure starting at 5 -10 psi which is increased until adequate
chest rise and fall is noted < 30 psi
Rate : 20 bursts per minute
insufflation should last approximately 1 second and exhalation should be
given 3- 4 seconds
An adequate expiratory phase is important to minimize the risk of
barotrauma
 Hand eye coordination of anaesthesialogist is imperative

Deeksha(191124008)
5) Numerous variations have been used in
microlaryngoscopy.
Structural modification of laryngoscope
Percutaneous transtracheal jet catheter
Carden tube
Orotracheal jet catheter
 Attachment of the jet injectors into lumen of
the laryngoscope

Deeksha(191124008)
Advantages of HFJV

Enhances surgical exposure

Less direct mucosal trauma than
endotracheal tube
 Increased oxygen tension for laser cases

Prajna (191124018)
 Does not provide definitive airway protection against
copious secretions or aspiration
Incomplete control of the airway
This is not laser safe with risk of airway fire- jet tubes
are not laser safe, tape used may cause ignition
Disadvantag Requires specialized training required by all that use it
es of HFJV and heightened communication between providers
 Degree of gas exchange is uknown until end tital
capnography or ABG obtained, i.e. Limited
conditions for monitoring gas exchange and
mechanics of ventilation in contrast to conventional
ventilation.

Prajna (191124018)
 If a definitive airway can easily and rapidly be secured
with endotracheal intubation
Significant direct damage to the cricoid cartilage or
larynx
Complete upper airway obstruction

Contraindicati Airway obstruction below the vocal cords that renders

exhalation difficult or impossible is a relative
ons of HFJV contraindication.
Foreign body which may be distally lodged
Severe tracheal stenosis, risk of excessive bleeding
during the procedure, patients at risk for aspiration
and exacerbation of lung diseases
 Obesity or poor pulmonary compliance
Prajna(191124018)
 Aspiration,GI insufflation, bleeding, pneumothorax,
subcutaneous emphysema, catheter as foreign body and
inadequate ventilation.
Barotrauma – intrapulmonary trapping of air as evidenced by
subcutaneous emphysema, pneumomediastinum, and
pneumothorax.

Complications Increased incidence with inadequate paralysis, laryngospasm,

obstructing lesions etc.
of HFJV Transtracheal jet ventilation was associated with a significantly
higher complication rate than transglottal jet ventilation. All
severe complications were related to barotraumas resulting from
airway outflow obstruction during jet ventilation, most often
laryngospasms.
 Routine postoperative CXR may not be useful following jet
ventilation for elective laryngotracheal surgery.

Gowthami (191124012)
Exposure to dry gas- Mucosal trauma,
tracheal necrosis, atelectasis.
Hypoxia and hypercapnia.
Hypotension
 Airway soiling by debris, secretions, vomitus.

Gowthami (191124012)
 Non-invasive ventilation (NIV) is the delivery of
oxygen (ventilation support) via a face mask and
therefore eliminating the need of an endotracheal
airway.
NIV achieves comparative physiological benefits to
Non – Invasive conventional mechanical ventilation by reducing the
work of breathing and improving gas exchange.
Ventilation
Before the 1960s nearly all techniques for mechanical
ventilation by non invasive.
 A tank/chest wrap device was used to apply sub
atmospheric pressure to the body/chest area to
ventilate the lungs.

Gowthami(191124012)
 The intervention is recognised as an
effective treatment for respiratory
failure in COPD, cardiogenic
pulmonary oedema and other
respiratory conditions without
complications such as respiratory
muscle weakness, upper airway
trauma, ventilator-associated
pneumonia, and sinusitis.

Gowthami(191124012)
 NIV works by creating a positive airway pressure – the
pressure outside the lungs being greater than the
pressure inside of the lungs.
This causes air to be forced into the lungs (down the
pressure gradient), lessening the respiratory effort
and reducing the work of breathing.
It also helps to keep the chest and lungs expanded by
Types of NIV increasing the functional residual capacity (the
amount of air remaining in the lungs after expiration)
after a normal (tidal) expiration; this is the air
available in the alveoli available for gaseous
exchange.
 There are two types of NIV non-invasive positive-
pressure (NIPPV) and Negative-Pressure Ventilation
(NPV)
Grace (191124006)
  NIPPV describes the delivery of oxygen at
Non – Invasive either constant or variable pressures via a
positive face mask, such as Bi-level Positive Airway
pressure Pressure (BiPAP) and Constant Positive
Airway Pressure (CPAP)

Grace(191124006)
 CPAP is the most basic level of support
and provides constant fixed positive
pressure throughout inspiration and
expiration, causing the airways to
CPAP remain open and reduce the work of
breathing.
 This results in a higher degree of
inspired oxygen than other oxygen
masks.
Grace(191124006)
 When a patient remains hypoxic despite medical intervention
 Atelectasis – Complete or partial collapse of a lung or lobe .
 Rib fractures – to splint the rib cage open; to stabilise the
fracture and prevent damage to the lung
 Type I respiratory failure
 Congestive Heart Failure
Indications  Cardiogenic pulmonary oedema
 Obstructive sleep apnoea
 Pneumonia: as an interim measure before invasive ventilation
or as a ceiling of treatment
 Nasal CPAP is more commonly used with infants.
 BiPAP

Grace(191124006)
 NIV is often described as BiPAP, however, BiPAP is
actually the trade name.
As the name suggests provides differing airway
pressure depending on inspiration and expiration.
The inspiratory positive airways pressure (iPAP) is
higher than the expiratory positive airways pressure
BiPAP (ePAP).
Therefore, ventilation is provided mainly by iPAP,
whereas ePAP recruits underventilated or collapsed
alveoli for gas exchange and allows for the removal of
the exhaled gas.
 In the acute setting, NIV is used in type 2 respiratory
failure (for example in a COPD exacerbation), with
respiratory acidosis (pH < 7.35)
Grace (191124006)
 Type II respiratory failure
Acidotic exacerbation of chronic obstructive
pulmonary disease (COPD)
Indications Increased work of breath causing ventilatory failure,
for example, hypercapnia (increased CO2 in arterial
blood gas), fatigue or neuromuscular disorder
 Weaning from tracheal intubation

Grace (191124006)
 Negative-pressure ventilators provide
ventilatory support using a device that
encases the thoracic cage, such as the iron
lung.
Negative – They work by lowering the pressure
pressure surrounding the thorax, creating
subatmospheric pressure which passively
ventilation expands the chest wall to inflate the lungs.
 Exhalation occurs with passive recoil of the
chest wall. Their use is still indicated in
chronic respiratory failure.

Grace(191124006)
 Coma
Undrained pneumothorax
Frank haemoptysis
Vomiting blood (haematemesis)
Facial fractures

Contraindicati Cardiovascular system instability

Cardiac Arrest
ons of NIV Respiratory Failure
Raised ICP
Recent upper GI surgery
Active Tuberculosis
Lung abscess
 No additional contraindications in the paediatric population

Grace(191124006)
Thank you