Skip to main content
Hauptrubriken
CME Facharzt-Training Webinare Zeitschriften Bücher e.Medpedia Podcast
Service
Jobbörse Info & Hilfe
Fachgebiete
Anästhesiologie Allgemeinmedizin Arbeitsmedizin Augenheilkunde Chirurgie Dermatologie Gynäkologie und Geburtshilfe HNO Innere Medizin Kardiologie Neurologie Onkologie und Hämatologie Orthopädie und Unfallchirurgie Pädiatrie Pathologie Psychiatrie Radiologie Rechtsmedizin Urologie Zahnmedizin
Themen
Klimawandel und Gesundheit Neues aus dem Markt COVID-19 Praxis und Beruf Seltene Erkrankungen GOÄ & EBM Panorama
Sammlungen
Kasuistiken Algorithmen & Infografiken Blickdiagnosen Arthropedia FlapFinder (für Dermatochirurgen) Videos Kongressberichterstattung Medizin für Apothekerinnen und Apotheker Für Ärztinnen und Ärzte in Weiterbildung Für Medizinstudierende
Erweiterte Suche
Anmelden
nach oben
Intensive Care Medicine
Erschienen in: Intensive Care Medicine 8/2003

01.08.2003 | Original

Alveolar recruitment of atelectasis under combined high-frequency jet ventilation: a computed tomography study

verfasst von: Paul Kraincuk, Günther Körmöczi, Mathias Prokop, Gerald Ihra, Alexander Aloy

Erschienen in: Intensive Care Medicine | Ausgabe 8/2003

Einloggen, um Zugang zu erhalten

Abstract

Objective

To quantify the effect of superimposed high-frequency jet ventilation on lung recruitment in adult patients with acute lung injury.

Design and setting

Prospective clinical study in the intensive care unit of a university teaching hospital.

Patients

Eight adults suffering from acute lung injury with a mean lung injury score of 2.6±0.6 and pronounced atelectasis in at least two lung quadrants. The cause was either pneumonia (n=5) or postoperative sepsis (n=3).

Interventions

Superimposed high-frequency jet ventilation was initiated in patients following a mean of 4.4±1.7 days of conventional ventilation. Before and 4 h after the start of superimposed high-frequency jet ventilation differential lung volumes were determined by volumetry using computed tomography.

Measurements and results

Superimposed high-frequency jet ventilation significantly increased the lung volume of every patient due to alveolar recruitment. This was achieved despite lower peak inspiratory pressures and higher PaO2/FIO2 ratios than with conventional ventilation.

Conclusions

Treatment with superimposed high-frequency jet ventilation for 4 h resulted in rapid alveolar recruitment in dependent lung areas, improved gas exchange, and better arterial oxygenation. It offers an effective and advantageous alternative to conventional ventilation for ventilatory management of respiratory insufficient patients.
Anhänge
Nur mit Berechtigung zugänglich
Literatur
1.
Belperio JA, Keane MP, Burdick MD, Londhe V, Xue YY, Li K, Phillips RJ, Stieter RM (2002) Critical role for CXCR2 and CXCR2 ligands during the pathogenesis of ventilator-induced lung injury. J Clin Invest 110:1703–1716CrossRefPubMed
2.
Puybasset L, Cluzel P, Chao N, Slutsky, Rouby JJ (1998) A computed tomography scan assessment of regional lung volume in acute lung injury. Am J Respir Crit Care Med 158:1644–1655PubMed
3.
Gattinoni L, Pelosi P, Crotti S, Valenza F (1995) Effects of positive endexpiratory pressure on regional distribution of tidal volume and recruitment in adult respiratory distress syndrome. Am J Respir Crit Care Med 151:1807–1814PubMed
4.
Amato MBP, Silvia CVB, Medeiros DM (1995) Beneficial effects on the Open Lung Approach with Low Distending Pressures in the Acute Respiratory Distress Syndrome. Am J Respir Crit Care Med 152:1836–1846
5.
Daniel P. Schuster, Miroslav Klein, James V. Snyder (1982) Comparison of high-frequency jet ventilation to conventional ventilation during severe acute respiratory failure in humans. Crit Care Med 10:625–630PubMed
6.
El Baz, Faber LP, Doolas A (1983) Combined high-frequency ventilation for management of terminal respiratory failure: a new technique. Anesth Analg 62:39–49PubMed
7.
Schragl E, Donner A, Kashanipur A, Aloy A (1995) Preliminary experience with superimposed high-frequency jet-ventilation in intensive care. Anaesthesist 44:429–435CrossRefPubMed
8.
Ihra G, Kolev N, Zackel D, Kepka A, Schabernig C, Aloy A (1999) Transoesophageal echocardiographic assessment of right heart hemo dynamics during high-frequency jet-ventilation. J Clin Anesth 11:32–38CrossRefPubMed
9.
MacIntyre NR (1998) High-frequency ventilation. Crit Care Med 25:1955–1956
10.
Roustan JP (1995) High-frequency jet-ventilation combined with conventional mechanical ventilation in the treatment of respiratory distress syndrome. Ann Fr Anesth Reanim 14:276–288PubMed
11.
Kraincuk P, Ihra G, Kepka A, Schabernig C, Aloy A (1999) A combined humidification and warming system under SHFJV. Crit Care 3:101–110CrossRefPubMed
12.
Ihra G, Kepka A, Schabernig C, Zimpfer M, Aloy A (1998) A jet-adapter for application of superimposed high-frequency jet-ventilation (SHFJV) via tube in intensive care: a new technique. Anaesthesist 47:209–219CrossRefPubMed
13.
Kalender WA (1995) Thin section three-dimensional spiral CT: is isotropic imaging possible? Radiology 197:578–579
14.
15.
Shah RM, Sexauer W, Ostrum BJ, Fiel SB, Friedmann AC (1997) High-resolution CT in the acute exacerbation of cystic fibrosis: evaluation of the acute findings, reversibility of those findings and clinical correlation. AJR Am J Roentgenol 169:375–380PubMed
16.
Gattinoni L, Pesenti L, Avalli F, Rossi M (1987) Pressure-volume curve of total respiratory system in acute respiratory failure: computed tomographic scan study. Am Rev Respir Dis 136:730–736PubMed
17.
Keszler M, Klappenbach RS, Reardon E (1988) Lung pathology after high frequency jet ventilation combined with low rate intermittent mandatory ventilation in a canine model of meconium aspiration. Pediatr Pulmonol 4:144–149PubMed
18.
Andersen JB (1989) Ventilatory strategy in catastrophic lung disease. Inversed ratio ventilation (IRV) and combined high frequency ventilation (CHFV). Acta Anaesthesiol Scand Suppl 90:145–148PubMed
19.
Velmahos GC, Chan LS, Tatevossian R, Cornwell EE 3rd, Dougherty WR, Escudero J, Dematriades D (1999) High-frequency percussive ventilation improves oxygenation in patients with ARDS Chest 116:440–446
20.
Cortiella J, Mlcak R, Herndon D (1999) High-frequency percussive ventilation in pediatric patients with inhalation injury. J Burn Care Rehabil 20:232–235PubMed
21.
Tanaka M, Terai T, Suzuki N (2001) Superimposed high-frequency jet ventilation induced deterioration of oxygenation during whole lung lavage in a patient with pulmonary alveolar proteinosis. Masui 50:779–782PubMed
22.
Lanzenberger-Schragl E, Donner A, Grasl MC, Zimpfer M, Aloy A (2000) Superimposed high-frequency jet ventilation for laryngeal and tracheal surgery. Arch Otolaryngol Head Neck Surg 126:40–44PubMed
23.
Aloy A, Schragel E (1994) Jetventilation klinische Anwendung und technische Grundlagen. Springer, Berlin Heidelberg New York
24.
Chang HK (1984) Mechanisms of gas transport during ventilation by high-frequency oscillation. J Appl Physiol 56:553–563PubMed
25.
Beamer WC, Prough DS, Royster RL, Johnston WE, Johnson JC (1984) High-frequency jet ventilation produces auto-PEEP. Crit Care Med 12:734–737PubMed
26.
Conti G, Bufi M, Rocco M, Calzecchi E, De Blasi RA, Antonelli M, Pelaia P, Gasparetto A (1990) Auto-PEEP and dynamic hyperinflation in COPD patients during controlled mechanical ventilation and high frequency jet ventilation. Intensive Care Med 16:81–84PubMed
27.
Myles PS, Evans AB, Madder H, Weeks AM (1997) Dynamic hyperinflation: comparison of jet ventilation versus conventional ventilation in patients with severe end-stage obstructive lung disease. Anaesth Intensive Care 25:471–475PubMed
28.
Ihra G, Aloy A (2000) On the use of Venturi's principle to describe entrainment during jet ventilation. J Clin Anesth 12:417–419
29.
Horton WG, Cheney FW (1975) Variability of effect of end-expiratory pressure. Arch Surg 110:395–398PubMed
30.
Kanarek DJ, Shannon DC (1975) Adverese effect of positive end-expiratory pressure on pulmonary perfusion and arterial oxygenation. Am Rev Respir Dis 112:457–459PubMed
31.
Kolobow T, Moretti MP, Fumagalli R, Prato P, Chen V, Jonz M (1987) Severe impairment in lung function induced by high peak airway pressure during mechanical ventilation: an experimental study. Am Rev Respir Dis 135:312–315PubMed
32.
Gattinoni L, Bombino M, Pelosi P, Dissoni A, Pesenti A, Fumagalli R, Tagliabue M (1994) Lung structure and function in different stages of severe adult respiratory distress syndrome. JAMA 271:1772–1779PubMed
33.
Muscedere JC, Mullen JBM, Gan K, Slutsky AS (1994) Tidal ventilation at low pressures can augment lung injury. Am J Respir Crit Care Med149:1327–1334
34.
Gattinoni L, Pelosi P, Sluter M, Peduto A, Vercesi P, Dissoni A (1998) Acute respiratory distress syndrome due to pulmonary and extrapulmonary disease: different syndromes? Am J Respir Crit Care Med 156:1082–1091
35.
Gattinoni L, Pesenti A, Torrersin A, Baglioni S, Rivolta M, Scarani F, Marcolin R (1986) Adult respiratory distress syndrome profiles by computed tomography. J Thorac Imaging 1:25–30
36.
Gattinoni L, Mascheroni D, Torresin A, Marcolin R, Fumagalli R, Vesconi S, Rossi GP, Rossi F, Baglioni S, Bassi F (1986) Morphological response to positive endexpiratory pressure in acute respiratory failure Computerized tomography study. Intensive Care Med 12:137–142PubMed
37.
Pesenti A, Tagliabue P, Patroniti N, Fumagalli R (2001) Computerized tomography scan imaging in acute respiratory distress syndrome. Intensive Care Med 27:631–639
38.
Gattinoni L, Bombino M, Pelosi P, Lissoni A, Pesenti A, Fumagalli R, Tagliabue M (1994) Lung structure and function in different stages of severe adult respiratory distress syndrome. JAMA 271:1772–1779PubMed
39.
Pelosi P, Crotti S, Brazzi L, Gattinoni L (1996) Computed tomography in adult respiratory distress syndrome: what has it taught us? Eur Respir J 9:1055–1062
40.
Puybasset L, Cluzel P, Gusman P, Grenier O, Rouby JJ (2000) Regional distribution of gas and tissue in acute respiratory distress syndrome. I. Consequences for lung morphology. Intensive Care Med 26:857–869PubMed
Metadaten
Titel
Alveolar recruitment of atelectasis under combined high-frequency jet ventilation: a computed tomography study
verfasst von
Paul Kraincuk
Günther Körmöczi
Mathias Prokop
Gerald Ihra
Alexander Aloy
Publikationsdatum
01.08.2003
Verlag
Springer-Verlag
Erschienen in
Intensive Care Medicine / Ausgabe 8/2003
Print ISSN: 0342-4642
Elektronische ISSN: 1432-1238
DOI
https://doi.org/10.1007/s00134-003-1828-6

Weitere Artikel der Ausgabe 8/2003

Intensive Care Medicine 8/2003 Zur Ausgabe

Correspondence

Case report medication error: oral antibiotics and simethicone accidentally injected intravenously

Original

Effect of cardiopulmonary bypass on lactate metabolism

Experimental

Positive end-expiratory pressure modulates local and systemic inflammatory responses in a sepsis-induced lung injury model

Brief Report

Is elevated plasma lactate a useful marker in the evaluation of pure carbon monoxide poisoning?

Editorial

Is monocyte HLA-DR expression predictive for clinical outcome in sepsis?

Experimental

Aerosolization of perfluorocarbons during mechanical ventilation: an in vitro study

Neu im Fachgebiet AINS

Bei schweren Reaktionen auf Insektenstiche empfiehlt sich eine spezifische Immuntherapie

25.04.2024 Allergien und Intoleranzreaktionen Nachrichten

Insektenstiche sind bei Erwachsenen die häufigsten Auslöser einer Anaphylaxie. Einen wirksamen Schutz vor schweren anaphylaktischen Reaktionen bietet die allergenspezifische Immuntherapie. Jedoch kommt sie noch viel zu selten zum Einsatz.

Hinter dieser Appendizitis steckte ein Erreger

23.04.2024 Appendizitis Nachrichten

Schmerzen im Unterbauch, aber sonst nicht viel, was auf eine Appendizitis hindeutete: Ein junger Mann hatte Glück, dass trotzdem eine Laparoskopie mit Appendektomie durchgeführt und der Wurmfortsatz histologisch untersucht wurde.

Ärztliche Empathie hilft gegen Rückenschmerzen

23.04.2024 Leitsymptom Rückenschmerzen Nachrichten

Personen mit chronischen Rückenschmerzen, die von einfühlsamen Ärzten und Ärztinnen betreut werden, berichten über weniger Beschwerden und eine bessere Lebensqualität.

Mehr Schaden als Nutzen durch präoperatives Aussetzen von GLP-1-Agonisten?

23.04.2024 Operationsvorbereitung Nachrichten

Derzeit wird empfohlen, eine Therapie mit GLP-1-Rezeptoragonisten präoperativ zu unterbrechen. Eine neue Studie nährt jedoch Zweifel an der Notwendigkeit der Maßnahme.

Update AINS

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.

hier abonnieren
Bildnachweise