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#JanuAirway Day 15. Jet Ventilation – a bit more niche in anaesthesia / airway management, but fascinating. Here’s a #OnePager covering the basics.
@AirwayFirst @AirwayInfo @dasairway @dastrainees @theairwaysite @OTJOnline @UniversalAirway @lizrossauc #FOAMed
1/8
@AirwayFirst @AirwayInfo @dasairway @dastrainees @theairwaysite @OTJOnline @UniversalAirway @lizrossauc #FOAMed
1/8
#JanuAirway 2 modes of jet ventilation – low frequency (<60 jets/min) & high frequency (>60). Frequency determines device. 2 commonly used devices – Manujet (modified hand operated Sanders injector) or Monsoon (specialised jet ventilator). Here’s a some #OnePagers #FOAMed
2/8
2/8
#JanuAirway Several different potential mechanisms to apnoic oxygenation during HFJV, including: -
• Bulk flow
• Laminar flow
• Taylor dispersion
• Pendelluft
• Molecular diffusion
• Cardiogenic mixing
https://derangedphysiology.com has a great article & this diagram #FOAMed
3/8
• Bulk flow
• Laminar flow
• Taylor dispersion
• Pendelluft
• Molecular diffusion
• Cardiogenic mixing
https://derangedphysiology.com has a great article & this diagram #FOAMed
3/8
#JanuAirway. Key clinical pearl is critical airway diameter for exhalation. Dworkin et al ( https://www.sciencedirect.com/science/article/abs/pii/S0888629609900126) showed that jetting across a Glottis diameter <4.0-4.5mm --> gas trapping (independent of jet ventilator settings). There MUST be a path for exhalation #FOAMed
4/8
4/8
#JanuAirway 3 route for jet ventilation: -
• Supraglottic – attached to a surgical laryngoscope
• Transglottic – using a specialised jet ventilation catheter
• Transtracheal – using a cannula via the cricothyroid membrane
Here are some #OnePagers on the equipment #FOAMed
5/8
• Supraglottic – attached to a surgical laryngoscope
• Transglottic – using a specialised jet ventilation catheter
• Transtracheal – using a cannula via the cricothyroid membrane
Here are some #OnePagers on the equipment #FOAMed
5/8
#JanuAirway
Here are some papers / links that you might find interesting: -
a. https://academic.oup.com/bjaed/article/17/7/242/3921240?searchresult=1
b.
c.
d. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6550456/
6/8 #FOAMed
Here are some papers / links that you might find interesting: -
a. https://academic.oup.com/bjaed/article/17/7/242/3921240?searchresult=1
b.
c.
d. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6550456/
6/8 #FOAMed
#JanuAirway HFJV is also used outside ENT, in IR & cardiac cath labs to improve image quality. In these environments, I use the following set-up to ensure airway protection, whilst allowing HFJV. Can leave open to air (pre-COVID) or connected to circuit with APL valve open
7/8
7/8
Hope that helps. Tomorrow we'll take a look into Needle Techniques for CICO. See you then! #JanuAirway @AirwayFirst @AirwayInfo @AirwayHub @Dasairway @UniversalAirway @Theairwaysite @GAMCLondon2020 @NicholasChrimes
8/8
8/8
