High frequency jet ventilation in interventional fiberoptic bronchoscopy

High frequency jet ventilation (HFJV) is a well accepted method for securin g ventilation in rigid and interventional bronchoscopy. We describe a techn ique of HFJV using a 14F nylon insufflation catheter placed in the trachea to support stent implantation or endobronchial balloon dilation in endobron chial stenoses with the flexible fiberscope. One hundred sixty-one cases we re treated with either a metal wire stent (n = 105) or with balloon dilatio n (n = 56). In addition to HFJV, IV anesthesia was applied in 132 cases. Dr iving pressure was 1125-1275 mm Hg, frequency 80-100/min, and inspiratory:e xpiratory ratio of 1:2. Fraction of inspired oxygen ranged from 0.3-1.0. Th e effects on alveolar ventilation were assessed by using blood-gas analysis and continuous monitoring of transcutaneous oxygen and carbon dioxide tens ion (PtcCO2). Complications consisted of hypertension (n = 8), hypotension (n = 6) bronchospasm (n = 5), and hypoxia (n = 6). In 52% of the cases, mil d hypercarbia (P(tc)CO2 50 - 60mm Hg) was observed. In two cases, a PtcCO2 > 80mm Hg resolved spontaneously when the patients returned to normal breat hing after intermittent superimposed ventilation with a face mask. During p lacement of stents in the proximal trachea, the jet. catheter had to be wit hdrawn, resulting in displacement of the catheter into the pharynx in one c ase, which was managed safely with the bronchoscope. In conclusion, HFJV ac hieves satisfactory operating conditions and provides adequate gas exchange for interventional bronchoscopic procedures with the fiberscope.