OBJECTIVES: High-frequency jet ventilation (HFJV) is a convenient method for providing ventilation during fiberoptic bronchoscopy. We describe an incipient approach of high-frequency jet ventilation via the working channel of a flexible bronchoscope for nonintubated patients who suffer from hypoxemia during bronchoscopy. The aim of this study was to test the efficacy of this incipient approach and determine the possible complications related to it. MATERIALS AND METHODS: Sixteen patients who had oxygen saturation below 70% that did not resolve with nasal oxygen for 20 s during interventional bronchoscopy were included in the study. High-frequency jet ventilation was administrated via the working channel of a bronchoscope for 3 min. Arterial blood gas circumscriptions were compared before and after jet ventilation. RESULTS: Oxygen saturation increased to >90% in all patients 30 s after jet ventilation. Mean arterial oxygen saturation pressure increased from 54.84 to 111.98 mmHg with jet ventilation (p=0.0001). Arterial carbon dioxide tension decreased after jet ventilation. The body mass index had no consequential effect on arterial carbon dioxide pressure after jet ventilation in our patients (p=0.1). Complications such as pneumothorax and working channel damage were not observed. CONCLUSION: High-frequency jet ventilation via the working channel of the bronchoscope is a novel method that can provide optimal ventilation with minimal complications to nonintubated patients suffering from hypoxemia during bronchoscopy. This method also reduces the duration of bronchoscopy procedures. Key Words: High-frequency jet ventilation, bronchoscopy, hypoxemia, ventilation, flexible bronchoscopy Cite this article as: Abedini A, Kiani A, Taghavi K, et al. High-Frequency Jet Ventilation in Nonintubated Patients. Turk Thorac J 2018; 19(3): 127-31. http://www.turkthoracj.org/eng/ozet/978/176/Abstract
Turk Thorac J 2018; 19(3): 127-31
Original Article
High-Frequency Jet Ventilation in Nonintubated Patients
Fiberoptic bronchoscopy has been widely utilized over the last years in pulmonary medicine for diagnosis and treatment
of pulmonary diseases such as pleural tumors, tuberculosis, and lipoid pneumonia [1-3]. Qualified ventilation in sedated
patients during bronchoscopy is an issue of utmost consequentiality. Nasal oxygen supply is adequate for maintaining
conventional oxygen saturation (So2) of over 90% in mildly sedated patients. However, when deeper sedation is needed
during the procedure, dropping oxygen (O2) and elevating carbon dioxide (CO2) pressures as well as acidemia and
arrhythmia are the frequent quandaries faced. Different approaches have been introduced for ventilating deeply sedated
patients [1]. Conventional mechanical ventilation (CMV) conventionally does not ameliorate O2 supplementation during
bronchoscopy in sedated patients. Therefore, providing ventilation in this setting is vital.
High-frequency jet ventilation (HFJV) is an opportune technique that distributes a minuscule tidal volume with a fre-
quency exceeding the physiologic level of the patient [3-5]. HFJV can be applied via supraglottic [such as laryngeal mask
airway (LMA)], transtracheal, or subglottic approaches [6-9]. All of the three methods truncate the expiratory time and
linearly increase the pulmonary capillary wedge pressure and greatest sanctioned working pressure.
The supraglottic HFJV provides the most rapid increase in airway pressure. Transtracheal HFJV approach provides the
most consistent atmospheric pressure of the fraction of inspired oxygen (FiO2). However, both methods increase the peril
DOI: 10.5152/TurkThoracJ.2018.17025
Atefeh Abedini1 , Arda Kiani2 , Kimia Taghavi1 , Ali Khalili3, Alireza Jahangiri Fard4 , Lida Fadaizadeh5 ,
Alireza Salimi1 , Tahereh Parsa6 , Akram Aarabi4 , Behrooz Farzanegan2 ,
Mahsa Pourabdollah Tootkaboni1
1Chronic Respiratory Diseases Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid
Beheshti University of Medical Sciences, Tehran, Iran
2Tracheal Diseases Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti
University of Medical Sciences, Tehran, Iran
3Tobacco Prevention and Control Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid
Beheshti University of Medical Sciences, Tehran, Iran
4Lung Transplantation Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti
University of Medical Sciences, Tehran, Iran
5Telemedicine Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti
University of Medical Sciences, Tehran, Iran
6Pediatric Respiratory Diseases Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid
Beheshti University of Medical Sciences, Tehran, Iran
Address for Correspondence: Arda Kiani, Tracheal Diseases Research Center, National Research Institute of Tuberculosis and Lung
Diseases (NRITLD), Massih Daneshvari Hospital, Tehran, Iran
E-mail: ardakiani@sbmu.ac.ir
©Copyright 2018 by Turkish Thoracic Society - Available online at www.turkthoracj.org 127
Cite this article as: Abedini A, Kiani A, Taghavi K, et al. High-Frequency Jet Ventilation in Nonintubated Patients. Turk Thorac J
2018; 19(3): 127-31.
OBJECTIVES: High-frequency jet ventilation (HFJV) is a convenient method for providing ventilation during beroptic bronchoscopy. We
describe an incipient approach of high-frequency jet ventilation via the working channel of a exible bronchoscope for nonintubated
patients who suffer from hypoxemia during bronchoscopy. The aim of this study was to test the efcacy of this incipient approach and
determine the possible complications related to it.
MATERIALS AND METHODS: Sixteen patients who had oxygen saturation below 70% that did not resolve with nasal oxygen for 20 s
during interventional bronchoscopy were included in the study. High-frequency jet ventilation was administrated via the working chan-
nel of a bronchoscope for 3 min. Arterial blood gas circumscriptions were compared before and after jet ventilation.
RESULTS: Oxygen saturation increased to >90% in all patients 30 s after jet ventilation. Mean arterial oxygen saturation pressure in-
creased from 54.84 to 111.98 mmHg with jet ventilation (p=0.0001). Arterial carbon dioxide tension decreased after jet ventilation. The
body mass index had no consequential effect on arterial carbon dioxide pressure after jet ventilation in our patients (p=0.1). Complica-
tions such as pneumothorax and working channel damage were not observed.
CONCLUSION: High-frequency jet ventilation via the working channel of the bronchoscope is a novel method that can provide opti-
mal ventilation with minimal complications to nonintubated patients suffering from hypoxemia during bronchoscopy. This method also
reduces the duration of bronchoscopy procedures.
KEYWORDS: High-frequency jet ventilation, bronchoscopy, hypoxemia, ventilation, arterial oxygen, exible bronchoscopy
Received: 18.03.2017 Accepted: 10.04.2018
of blowing debris, barotrauma, and hypercapnia [5,6]. In
comparison with these, complications are minimized with
the subglottic approach. Furthermore, PAWP can be observed,
and the distributed FiO2 can be determined. Recently, sub-
glottic HFJV was utilized broadly via different bronchoscope
channels. However, the working channel of the broncho-
scope (utilized for suction, oxygen distribution, and local
anesthesia administration) has not been applied before in
any study.
We evaluated a novel technique in nonintubated sedated
patients undergoing flexible bronchoscopy (HFJV via the
working channel) in this study.
Study Design
This randomized clinical tribulation study was designed by
an expert methodologist. The final study population was
estimated to be 10-20 patients. The research project was
approved by the ethics committee and review board of
Shadid Behehti University of Medical Sciences (IR. SBMU.
MSP. REC.1395.218), and ethical clearance conformed to the
Declaration of Helsinki. To comply with health indemnifica-
tion portability, the principle of secrecy of patient informa-
tion was taken into consideration.
Study Population
In total, 150 patients with asthmatic bronchitis and chronic
bronchitis underwent interventional flexible fiberoptic bron-
choscopy for diagnosis or treatment during April-August
2016. Patients signed apprised informed consents after the
study procedure was explained to them. Intervention opera-
tions were routine operative procedures, and none of them
were set for clinical research.
Baseline demographic characteristics including age, gender,
and body mass index (BMI) were recorded for further analy-
sis. Ecumenical guidelines were utilized in determining the
normality of limits [10]. After quantifying the blood pressure
and performing electrocardiogram, patients underwent deep
sedation using a resilient instauration short-half-life drug
(propofol with an infusion rate of 50-75 µg/kg/min; mid-
azolam: 0.02 mg/kg; and fentanyl: 1-2 µg/kg). Sedation status
was monitored using a bispectral index of 60. All bronchos-
copy operations were conducted using a conventional flexi-
ble bronchoscope (BF-1T260, Olympus Tokyo, Japan). The
outer and main diameters of the working channel were 5.9
and 2.8 mm, respectively, which comply with the national
guidelines [10]. Vital signs and So2 were monitored and
CMV approaches were provided during the procedure.
Patients were further monitored using pulse oximetry for O2
saturation during the different prep times of each patient for
approximately 30-60 min. If SpO2 decreased below 70% and
did not resolve within 20 s of nasal oxygenation, the patient
was recommended for study inclusion and HFJV administra-
tion. The inclusion criterion was 70% O2 saturation for 20 s
as the borderline (the greatest time of abiding the least satura-
tion). The omission criteria included rigorous cardiac dis-
eases and unstable hemodynamics. Arterial blood sample
was accumulated to determine the arterial blood gas (ABG).
HFJV (Monsoon, Acutronic Medical Systems AG, Baar,
Switzerland) was applied for 3 min via the working channel
of the bronchoscope. HFJV was performed with the following
parameters: inspiration time of 45%, driving pressure of 3
bar, peak pressure of 80 mbar, FiO2 of 30%-100%, and fre-
quency (ventilator rate) of 250/min. After applying HFJV for
3 min to obtain an incremented SpO2 to 90%, second arte-
rial blood sampling was performed, and the bronchoscopy
procedure was commenced (Figure 1,2). The arterial blood
Figure 1. Non-intubated sedated patient under HFJV during bronchoscopy
with a flexible fiberoptic bronchoscope via the working channel
Figure 2. Jet ventilator catheter
Turk Thorac J 2018; 19(3): 127-31
pH was compared in two blood samples. The estimated ven-
tilation efficacy and the availability of oxygen was obtained
by comparing the partial pressure of carbon dioxide (PaCO2)
(mmHg) and the arterial partial pressure of oxygen (PaO2)
(mmHg) in two samples. The design of the current study is
shown on Figure 3.
Statistical Analysis
Data were statistically analyzed using paired t-test and
ANOVA using (SPSS) Statistical Package for Social Sciences
version 22.0 (IBM Corp.; Armonk, NY, USA). Statistical
analyses were conducted following international statistical
standards. The perpetual analysis of variables such as age,
gender, and BMI were presented as frequency and percent-
age and mean (±standard deviation) or median (minimum-
maximum). Categorical variables were expressed as frequen-
cies and percentages. The variables for between-group differ-
ences of the mean were calculated using Student’s t-test with
significance set at p<0.05. Different parameter correlations
were resolved using one-way ANOVA correlation coefficient.
Demographics Analysis
The normality of variables was obtained using Kolmogorov-
Smirnov test. Sixteen patients [10 males (62.5%) and 6
females (37.5%)] met the inclusion criteria. The patients’ age
range was 37-75 years, with a mean age of 56±9.95 years.
BMI of patients was in the range of 20.8-41 kg/m2, with a
mean of 31.6±5.5 kg/m2. Two (12.5%) patients showed mun-
dane BMI; 3 (18.8%) patients were inordinately corpulent
and 11 (68.8%) were exorbitantly corpulent, according to
International World Health Organization (Table 1).
Clinical Analysis
High-frequency jet ventilation increased SpO2 to more than
95% in less than 30 s in all 16 patients. The analysis of two
ABG samples showed that mean PaCO2 decreased from
59.3±6.7 to 52.6±8.09 mmHg after 3 min of jet ventilation.
Paired t-test showed that PaCO2 decreased significantly by
applying HFJV (p=0.001). Arterial pH also increased from
7.29±0.03 to 7.30±0.04 after jet ventilation. However, these
changes were not significant according to the paired t-test
analysis (p=0.08). Mean PaO2 was 54.84 mmHg (PaO2/FiO2
ratio<300) before jet ventilation and increased significantly to
111.98 mmHg (P/F ratio~575) with HFJV. (p=0.0001). Partial
pressure of carbon dioxide (PCO2) was 53.2±0.9 mmHg in
patients with mundane BMI and 52.3±12.1 mmHg in inordi-
nately corpulent patients. Despite our prospects, no significant
differences were observed in PCO2 in individuals with different
BMI status on the basis of one-way ANOVA p=0.1) (Table 2).
Post-procedure Recovery
Leak test was conducted after each procedure to estimate the
possible complications associated with HFJV such as tearing of
the working channel of the fiberoptic bronchoscope. However,
no positive test was reported. To check for pneumothorax as
Table 1. Baseline demographic characteristics and BMI
Parameters Values
Age (year) (mean±SD) 56±9.95
Gender (M/F) 10/6
Body mass index (kg/m2) 31.6±5.5
Cause of intervention procedure
Asthmatic bronchitis, no. (%) 7 (44)
Chronic bronchitis, no. (%) 9 (66)
BMI NL (%) 12.5
Overweight (%) 18.8
Obese (%) 68.8
BMI: body mass index; SD: standard deviation
Figure 4. HFJV connected to the working channel of a flexible fiberoptic
Figure 3. Design of current randomized clinical tribulation study
150 patients were referred with asthmatic
bronchitis and chronic bronchitis diagnosis
during April-August 2016
3 patients were excluded
from the study due to
rigorous cardiac diseases and
unstable hemodynamics
First arterial blood sample
was accumulated to figure
arterial blood gases (ABG)
Approval diagnostic or treatment
interventional flexible fiber optic
bronchoscopy was operated
HFJV was applied for 3 minutes through the bronchoscope
working channel with Inspiration Time (IT): 45%, Driving
pressure: 3 bar, Peak pressure: 80 mbar, FiO2: 30-100%,
Frequency (Ventilator rate): 250/min
After stabilizing patients SpO2 to 90%, second
arterial blood sampling was performed and the
bronchoscopy procedure was commenced
Sixteen patients
(10 men and 6 women)
consummated the
inclusion criteria
19 patients were recognized as HFJV
necessity case due to SpO2 70% under for
twenty seconds or above
Abedini et al. Bronchoscopy High-Frequency Jet Ventilation
another complication of HFJV, we performed chest radiogra-
phy after the procedure and every 2 h twice. No pneumotho-
rax or other complications attributable to HFJV were observed.
High-frequency jet ventilation has been applied during
interventional bronchoscopy since 1977. The variable
methods of HFJV and the associated complications have
been studied. Veres et al. [11] studied HFJV via LMA and
achieved qualified ventilation during the procedure.
However, they reported mild hypercapnia due to hypoven-
tilation as the most mundane minor unpropitious effect of
LMA-HFJV. They also reported that the LMA-HFJV tech-
nique resulted in the extension of the bronchoscopy dura-
tion due to removal of the bronchoscope and application of
the ventilation mask when hypoxemia occurred. In an ear-
lier study, Fernandez-Bustamante et al. [12] applied inter-
ventional rigid bronchoscopy connected to a transvector for
ventilation; they reported hypercapnia, hypoxemia, and
transient hemodynamic changes as the most common com-
plications of this HFJV technique. HFJV has been increas-
ingly utilized using nasotracheal or tracheal catheters via
the lateral port of the rigid bronchoscope, via the transtra-
cheal route, or by moving the catheter in the bronchoscope
[13-21]. Hautmann et al. [19] studied HFJV using a tra-
cheal catheter; they achieved adequate gas exchange dur-
ing the bronchoscopy procedure and observed no hypoxia
and hypotension. However, hypercapnia was the most com-
mon complication during their approach.
The current study aimed to introduce a novel HFJV method
to achieve optimal ventilation support and mitigate compli-
cations during bronchoscopy. We delivered HFJV via the
working channel of a flexible fiberoptic bronchoscope to
nonintubated sedated patients who suffer from hypoxemia.
To designate a borderline hypoxemia index, the following
study design was evaluated: SpO2 below 75% is the border-
line of rigorous hypoxemia and SpO2 of 65% and below is
the index value at which the patient will lose consciousness.
Jet ventilation should never be resumed until the airway is
open. Considering that mucus clogged the airway in most of
our patients, conventional ventilations were applied at the
maximum time to open the airway felicitously. Given that
vital organs such as the encephalon have 20 s worth of oxy-
gen storage capacity, 70% O2 saturation for 20 s was desig-
nated as the borderline inclusion criterion (the maximum
time of abiding the minimum saturation).
Considering the lack of access to capnography, we analyzed
ABGs before and after jet ventilation to evaluate ventilation
efficacy and possible ventilator setting adjustment needed.
PaCO2 was found to be significantly reduced in our study
after jet ventilation (p=0.001), whereas PaO2 significantly
increased (p=0.0001). The congruous results favor the effi-
cacy of the current incipient approach, which provides con-
gruous ventilation to patients during bronchoscopy.
A P/F ratio<300 is equivalent to a partial pressure of oxygen
(pO2) <60 mmHg; a P/F ratio<250 is equivalent to a pO2<50
mm Hg; and a P/F ratio<200 is equivalent to a pO2<40 mm
Hg on room air. The P/F ratio significantly increased after
HFJV (p=0.0001). Arterial pH additionally increased after jet
ventilation, but the incrimination was not paramount after 3
min in our patients (p=0.08). However, given that most of our
patients had chronic respiratory acidosis due to asthmatic
bronchitis and chronic bronchitis, the arterial pH results
might have been affected.
Generally, PCO2 reflects the exchange of this gas through the
lungs to the outside air. Some degrees of pulmonary diseases
with hyperventilation cause pH elevation. Pulmonary edema
and acute asthmatic attacks affect lung capacity for freely
exchanging CO2 across the alveolar membrane, thus, leading
to high PCO2 levels.
Additionally, decreased pH is related to ventilation failure
and severe degrees of pulmonary diseases. Overweight indi-
viduals who are hyperventilating will breathe more rapidly
and deeply and will blow off more CO2, thus, leading to low
PCO2 levels. We hypothesized that HFJV will lead to
increased pH in overweight individuals with high BMI.
Despite our prospects, differences in PCO2 value after HFJV
in the three variable BMI groups showed no significant differ-
ences (p=0.1).
Prolonged foreign bodies result in granulation formation in
the field of bronchoscopy. Recently, we utilized HFJV for
clearing the bronchoscopy field when perpetuated peregrine
body predisposed the field to bleeding during procedures.
The current method was used as an auxiliary method in
extracting the peregrine bodies. In pediatric patients, HFJV
was applied with caution and with low jet ventilation pres-
The issue of retracting the bronchoscope in hypoxemia dura-
tion was resolved by the current approach, and the proce-
dure was diverted. The whole procedure duration was mini-
Table 2. ABG changes after HFJV analysis using paired
Arterial blood Before jet Post jet
gas levels ventilation ventilation P
pH (mean±SD) 7.29±0.03 7.30±0.04 0.08
PaCO2 mmHg (kPa) 59.3±6.7 52.6±8.1 0.001
HCO3 (mmol/L)
PaO2 mmHg (kPa) 54.84 111.98 <0.001
(three digit
PaO2/FiO2 ratio <300 ~575 <0.001
PaCO2 (kPa/mmHg)
NL 50.9±1.02 53.2±0.0 0.1
Overweight 49.1±8.6 52.3±12.1
ANOVA: analysis of variance; pH: power of hydrogen; PaO2: partial
pressure of oxygen in the alveoli (mmHg); PaCO2: partial pressure of
carbon dioxide in arterial blood (mmHg); Std. Deviation: standard
Turk Thorac J 2018; 19(3): 127-31
mized, and the operator working field was not restricted. Our
procedures were conducted using a flexible bronchoscope
with a working channel diameter of 2.8 mm (Figure 4). We
have applied this method in over 100 recent procedures; the
reports and results of these procedures will be presented
soon. No damages were observed in the bronchoscope with
a working channel diameter of 2.8 mm. We also tried venti-
lation using a bronchoscope with a 2 mm working channel.
However, the use of a smaller working channel diameter
(<2.8 mm) led to high airway pressure and limited the venti-
lation. Thus, we do not recommend using HFJV through a
working channel with <2.8 mm diameter. Jet ventilation was
also ineffective in the working channel when there were too
many secretions because this method blew the secretions
into the airways and disturbed the ventilation method.
Considering that the maximum time of tolerating the mini-
mum saturation of oxygen was selected as the inclusion cri-
teria in the current study, only 16 patients fulfilled the sug-
gested index. A small study group in the current study may
have affected our results. Further studies with higher sample
sizes are required to offer enough data to confirm the effi-
cacy of the current approach.
The use of HFJV in the working channel of a flexible bron-
choscope is suggested to be an effective ventilation tech-
nique. This method delivers an open field for intervention
tools and provides adequate gas exchange without increas-
ing the risk of barotrauma.
Ethics Committee Approval: Ethics committee approval was received
for this study from the Ethics Committee of Shadid Behehti University
of Medical Sciences (IR. SBMU. MSP. REC.1395.218).
Informed Consent: Written informed consent was obtained from all
the patients who participated in this study.
Peer-review: Externally peer-reviewed.
Author contributions: Concept - A.A., A.K.; Design - A.A., A.K., L.F.,
A.S., T.P.; Supervision - A.A., A.K.; Resource - A.A., A.K., M.P.T.;
Materials - A.A., A.K., A.K.; Data Collection and/or Processing -
A.A., A.K., K.T.; Analysis and/or Interpretation - A.A., B.F., M.P.T.;
Literature Search - A.A., A.K., K.T.; Writing - A.A., A.K., K.T.; Critical
Reviews - A.A., A.K., K.T., A.K., A.J.F., L.F., A.S., T.P., A.A., B.F., M.P.T.
Acknowledgements: The authors would like to thank all the hospital
cooperators for their favor in conducting current study.
Conflict of Interest: The authors have no conflicts of interest to
Financial Disclosure: The authors declared that this study has
received no financial support.
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Abedini et al. Bronchoscopy High-Frequency Jet Ventilation
... В исследование A. Abedini и соавт. [40] включено 16 пациентов с исходной выраженной гипоксемией, показатель насыщения кислорода до процедуры не превышал 70%, среднее давление насыщения кислородом 54,8 мм рт. ст. ...
... ст. В исследовании показана оптимальность метода HFJV для проведения бронхоскопии, а именно эффективность самой манипуляции и оксигенации у пациентов с исходной гипоксемией [40]. ...
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... Since then, HFJV has become a technique to maintain ventilation. The application of this technique enables rapid pulsation gas to enter the respiratory tract through a narrow jet tube under low pressure [25,26]. HFJV has three characteristics [27][28][29], open system, high-frequency (> 60 bpm) and low tidal volume. ...
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Background: Supraglottic jet oxygenation and ventilation (SJOV) can effectively maintain adequate oxygenation in patients with respiratory depression, even in apnea patients. However, there have been no randomized controlled clinical trials of SJOV in obese patients. This study investigated the efficacy and safety of SJOV using WEI Nasal Jet tube (WNJ) for obese patients who underwent hysteroscopy under intravenous anesthesia without endotracheal intubation. Methods: A single-center, prospective, randomized controlled study was conducted. The obese patients receiving hysteroscopy under intravenous anesthesia were randomly divided into three groups: Control group maintaining oxygen supply via face masks (100% oxygen, flow at 6 L/min), the WNJ Oxygen Group with WNJ (100% oxygen, flow: 6 L/min) and the WNJ SJOV Group with SJOV via WNJ [Jet ventilator working parameters:100% oxygen supply, driving pressure (DP) 0.1 MPa, respiratory rate; (RR): 15 bpm, I/E; ratio 1:1.5]. SpO2, PETCO2, BP, HR, ECG and BIS were continuously monitored during anesthesia. Two-Diameter Method was deployed to measure cross sectional area of the gastric antrum (CSA-GA) by ultrasound before and after SJOV in the WNJ SJOV Group. Episodes of SpO2 less than 95%, PETCO2 less than 10 mmHg, depth of WNJ placement and measured CSA-GA before and after jet ventilation in the WNJ SJOV Group during the operation were recorded. The other adverse events were collected as well. Results: A total of 102 patients were enrolled, with two patients excluded. Demographic characteristics were similar among the three groups. Compared with the Control Group, the incidence of PETCO2 < 10 mmHg, SpO2 < 95% in the WNJ SJOV group dropped from 36 to 9% (P = 0.009),from 33 to 6% (P = 0.006) respectively,and the application rate of jaw-lift decreased from 33 to 3% (P = 0.001), and the total percentage of adverse events decreased from 36 to 12% (P = 0.004). Compared with the WNJ Oxygen Group, the use of SJOV via WNJ significantly decreased episodes of SpO2 < 95% from 27 to 6% (P = 0.023), PETCO2 < 10 mmHg from 33 to 9% (P = 0.017), respectively. Depth of WNJ placement was about 12.34 cm in WNJ SJOV Group. There was no significantly difference of CSA-GA before and after SJOV in the WNJ SJOV Group (P = 0.234). There were no obvious cases of nasal bleeding in all the three groups. Conclusions: SJOV can effectively and safely maintain adequate oxygenation in obese patients under intravenous anesthesia without intubation during hysteroscopy. This efficient oxygenation may be mainly attributed to supplies of high concentration oxygenation to the supraglottic area, and the high pressure jet pulse providing effective ventilation. Although the nasal airway tube supporting collapsed airway by WNJ also plays a role. SJOV doesn't seem to increase gastric distension and the risk of aspiration. SJOV can improve the safety of surgery by reducing the incidence of the intraoperative involuntary limbs swing, hip twist and cough. Trial registration: Chinese Clinical Trial Registry. Registration number, ChiCTR1800017028, registered on July 9, 2018.
... They showed that the rate of hypoxia (pO 2 < 60 mmHg) was very low (3.7%), though hypercapnia frequently occurred. A study by Abedini and colleagues conducted HFJV via the working channel of the bronchoscope in non-intubated patients with oxygen desaturation that did not resolve with nasal oxygen supplementation [86]. They showed a significant improvement in arterial oxygenation and carbon dioxide tension in a case series including 16 patients. ...
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Introduction: The incidence of peripheral pulmonary lesions (PPLs) is growing following the adoption of lung cancer screening by low-dose chest CT. Although CT-guided transthoracic needle aspiration has been the standard method to diagnose PPLs, the field of interventional bronchoscopy is rapidly advancing to overcome complications of the transthoracic approach yet maintain the yield. Areas covered: This article reviews the clinical evidence of recent emerging interventional bronchoscopic techniques for diagnosis of PPLs. Expert opinion: Recent advances in interventional bronchoscopy contribute to not only the safety of transbronchial approaches to PPLs but also the higher diagnostic yield. To perform accurate sampling of PPLs, bronchoscopists must select the correct airway, approach the target as close as possible, and confirm the location of the target before sampling. These key steps can be assisted by recently developed technologies. However, it is important for bronchoscopists to understand the strengths and limitations of these emerging technologies.
... IAH links to elevated SOFA scores, high APACHE II, high APACHE III, a further need for mechanical ventilation and insufficient PaO2: FiO2 ratios at admission time. Longer durations of the need for mechanical ventilation and lengths of stay at ICUs in such patients reaffirm the pathophysiological damages of raised ICP [19]. ...
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BACKGROUND: Abdominal compartment syndrome patients suffer severe obstacles such as kidney failure and shock. To evade further complications, identifying the abdominal compartment syndrome (ACS) and Intra-abdominal hypertension (IAH), in critically ill individuals and hospitalised in the intensive care unit (ICU) is obligated. AIM: The current study intended to study the abdominal compartment syndrome and the concomitant risk factors among hospitalised patients in ICU, by using the Intra-abdominal pressure test. MATERIAL AND METHODS: One hundred and twenty-five hospitalised patients at ICU entered the current survey. Abdominal pressure was measured by standard intravesical technique. The SPSS 21 analysed the preoperative and intraoperative factors such as demographic records and comorbidities. RESULTS: Seventy-three (58.4%) participants were males, and 52 (41.6%) were women in the mean age of 55.1 ± 18.3 years. Eighty-nine patients (71.2%) showed normal intra-abdominal pressure since 31 patients (24.8%), and 5 patients (4%) developed IAH and ACS. The intra-abdominal pressure (IAP) applied to Glasgow Coma Scale (GCS), Acute Physiology, shock, Systemic Inflammatory Response Syndrome (SIRS), central venous oxygen saturation and Chronic Health Evaluation (APACHE II) score (P < 0.05). Patients with high IAP have shown a higher mortality frequency, compared to others (P < 0.05). CONCLUSION: Current findings showed a correlation between IAP hospitalised patients in ICU and shock, SIRS, APACHE II, central venous oxygen saturation and GCS. Intra-abdominal pressure test, as a valuable prognosis test for the abdominal compartment syndrome (ACS) and Intra-abdominal hypertension (IAH), may offer better results when added to the routine medical checkup of ICU patients.
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Authors Hamidreza Jamaati, Shahram Kahkouee, Mohsen Farrokhpour, Mitra Rezaei, Fatemeh Mir-Aboutalebi, Kimia Taghavi Publication date 2017 Journal Paripex. Indian Journal of Research Volume 6 Issue 7 Pages 1-9 Background: Lipoid pneumonia is a rare disease with presence of lipids in the alveoli from endogenous or exogenous sources. Endogenous Lipoid pneumonia complicated with Rheumatoid arthritis, Cytomegalovirus and Tuberculosis has seldom been documented. Current case of uncommon complicated endogenous lipoid pneumonia adds observational data to previous knowledge about the causes of the disease.
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Background . There is a growing controversy about the use of oronasal masks (ONM) or total facemask (TFM) in noninvasive positive pressure ventilation (NPPV), so we designed a trial to compare the uses of these two masks in terms of effectiveness and comfort. Methods . Between February and November 2014, a total of 48 patients with respiratory failure were studied. Patients were randomized to receive NPPV via ONM or TFM. Data were recorded at 60 minutes and six and 24 hours after intervention. Patient comfort was assessed using a questionnaire. Data were analyzed using t -test and chi-square test. Repeated measures ANOVA and Mann–Whitney U test were used to compare clinical and laboratory data. Results . There were no differences in venous blood gas (VBG) values between the two groups ( P>0.05 ). However, at six hours, TFM was much more effective in reducing the partial pressure of carbon dioxide (PCO2) ( P=0.04 ). Patient comfort and acceptance were statistically similar in both groups ( P>0.05 ). Total time of NPPV was also similar in the two groups ( P>0.05 ). Conclusions . TFM was superior to ONM in acute phase of respiratory failure but not once the patients were out of acute phase.
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Background Obesity is currently a global health challenge driven by a mix of behavioural, environmental and genetic factors. Up to date population-based disease burden estimates are needed to guide successful prevention and control efforts in African countries. We investigated the prevalence and population attributable fractions of overweight and obesity in Buea, the Southwest region of Cameroon. Methods Data are from a community-based cross-sectional study involving randomly selected adults conducted in 2016. Body mass index (BMI) was categorized according to the WHO classification. Multivariable logistic regressions were used to investigate factors independently associated with obesity. Corresponding population attributable fractions were estimated. Results Among the 1,139 participants, age-standardized prevalence (95% CI) of overweight and obesity were; 36.5 (33.7–39.3) and 11.1 (9.3–12.9) percent respectively. Mean BMI was 25.3 ± 4.3 kg/m²; women were heavier than men (25.8 vs. 24.4 kg/m²; p <0.0001). Factors associated with obesity were; female gender [odds ratio 3.20 (95% CI: 1.93–5.59)], age > 31 years [3.21 (1.86–5.28)] and being married [2.10 (1.60–3.51)]. At the population level; older age, being married, low level of education, high monthly income and physical inactivity accounted respectively for 11.9%, 21.8%, 11.6%, 6.4% and 8.7% of overweight and obesity among the women, while older age and being married explained 9.2% and 28.3% of overweight and obesity in men. Conclusion The prevalence of overweight and obesity in this semi-urban Cameroonian population is high, affecting over a third of individuals. Community-based interventions to control weight would need to take into account gender specificities and socio-economic status.
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Cite this Articlllle; Derakhshani Nezhad Z, Farnia P, Sheikholslami FM, Afraei Karahrudie M, Mozafari M, Seif S, Taghavi K, Ramazanzadeh R, Masjedi MR, Velayati AA. Prevalence of non-tuberculosis mycobacteria in patients referring to Mycobacteriology Research Center of Iran. Scientific Journal of Kurdistan University of Medical Sciences. 2014 Jun 15;19(2):31-9. Abstract: Background and Aim: Considering the increasing significance of diseases due to NTM all over the world, we investigated the burden of such diseases in our region. The aim of this study was to assess NTM prevalence from different clinical samples during a period of 8 years in Massih Daneshvari Hospital, in Iran. Material and method: This descriptive study was performed on 8322 samples obtained from pulmonary TB patients in Mycobacteriology Research Center from 2004 -2012. Using Tb1 and Tb2 primers, a 190 bp fragment of IS6110 gene was amplified in order to identify Mycobacterium species. Specimens with negative IS6110 PCR results were analyzed with PCR-RFLP using hsp65 gene, for NTM investigation. Results: Out of 8322 samples, we identified 124 (1.5%) strains of NTM. The mean age of the patients was 57 ± 18/9 years (age range: 7 - 88 years). 55/6 % of the patients were male. The most common species detected in our study were Mycobacterium simiae (44.3%), Mycobacterium chelonae (16.9%) and Mycobacterium kansasii (12.9%). Conclusion: We found a high prevalence rate of Mycobacterium simiae among our patients. Treatment protocols for NTM are different from the protocols for Mycobacterium tuberculosis complex, so early diagnosis of these species will be of great importance. Key words: NTM, Non tuberculous mycobacteria, hsp65 Keywords: Mycobacterium, Interleukin-10, Interleukin-12, Interferon, NTM, Non tuberculous mycobacteria, hsp65
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Cite this Article; Nasiri MJ, Varahram M, Shams M, Taghavi K, Farnia P, Velayati AA. Osteoarticular Tuberculosis in Iran, 2002 to 2011. Advances in Research. 2014; 2(9): 509-504. OR; Nasiri MJ, Varahram M, Shams M, Taghavi K, Farnia P, Velayati AA. Osteoarticular Tuberculosis in Iran, 2002 to 2011. https://www.semanticscholar.org/paper/Osteoarticular-Tuberculosis-in-Iran-%2C-2002-to-2011-Nasiri-Varahram/9449c28b5dfc15511fb579a75d87e595a837d092 Keywords : Tuberculosis; osteoarticular; Iran.
Background: Chest Radiograph accompanied by clinical and laboratory findings are required for diagnosis and follow-up of patients with suspected ventilator-associated pneumonia (VAP). However, there are no reliable data whether follow-up chest-X-ray (CXR) is needed or not, moreover, when the physicians request CXR and how many times CXR is required. We aimed to determine association of the clinical improvement with resolution of pulmonary infiltrates as well as time of resolution. Materials and methods: The patients with a diagnosis of VAP based on Clinical Pulmonary Infection Score (CPIS) were enrolled in this study. Clinical evaluation and follow-up were continued and CXR was performed sequentially in two-day intervals until clinical improvement or occurrence of other events including death. Fischer test used to analyze the association of clinical improvement with radiographic resolution. Results: Out of seventy -five patients, pneumonia was clinically improved in 48 cases. Mean duration of the clinical improvement was 5.3±4.5 days. Among these patients, pulmonary infiltrations in 44 patients were resolved completely (13.8±5.8 days). Twenty-seven patients had not any clinical improvement and all of them revealed no infiltration resolution according to the sequential imaging studies. Resolution of radiographic involvement significantly was associated with clinical improvement (p=0.000). Conclusion: Radiographic resolution occurs in most of patients who survived VAP and there is strong relationship between radiographic resolution and clinical improvement. Moreover, our data revealed CXR clearance is occurred earlier than previously was anticipated. Thus sequential follow-up CXR in VAP had no further clinical value.
The impact of mechanical forces on pathogenesis of airway remodeling and the functional consequences in asthma remains to be fully established. In the present study, we investigated the effect of repeated bronchoconstriction induced by methacholine (MCh) on airway remodeling and airway hyperresponsiveness (AHR) in rats with or without sensitization to an external allergen. We provide evidence that repeated bronchoconstriction, using MCh, alone induces airway inflammation and remodeling as well as AHR in non-allergen-sensitized rats. Also, we found that the airways are structurally and functionally altered by bronchoconstriction induced by either allergen or MCh in allergen-sensitized animals. This finding provides a new animal model for the development of airway remodeling and AHR in mammals and can be used for studying the complex reciprocal relationship between bronchoconstriction and airway inflammation. Further studies on presented animal models are required to clarify the exact mechanisms underlying airway remodeling due to bronchoconstriction and the functional consequences.
Background and objectives: Because there is no cure for idiopathic pulmonary artery hypertension (IPAH), improving survival and stabilizing disease are key aims in any treatment strategy for patients with IPAH. Intravenous (IV) administration of prostacyclin positively affects the symptoms and hemodynamic of patients with IPAH. This study sought to assess the efficacy of cyclic Iloprost administration in Iranian patients with IPAH. Materials and methods: This longitudinal study was conducted on 20 patients with IPAH. Upon hospitalization, the patients received intermittent IV administration of Iloprost 6 hours a day for 5 days; this cycle was repeated every 6 weeks, total duration of treatment was 12 months. New York Heart Association/World Health Organization (NYHA/WHO) functional classification (FC), 6-minute walk test (6MWT), mean pulmonary arterial pressure (PAPm), right ventricular pressure (RVP), and serum level of N-terminal pro b-type natriuretic peptide (NT-proBNP) were assessed at baseline, during and after completion of treatment course. The data were analyzed using SPSS version 13. Results: The FC, PAPm, and RVP significantly decreased after the treatment (P
Objective: Interventional bronchoscopy procedures are novel and effective modes of diagnosing and treating airway lesions. Airway management and ventilation are a major concern, especially when considering the fire hazard of ventilating during endobronchial thermal therapies. The aim of this study was to evaluate the usage of laryngeal mask airway (LMA) compared to rigid bronchoscopy for the ventilation of patients undergoing diagnostic or therapeutic interventional bronchoscopy procedures. Methods: During this prospective randomised clinical trial study, patients were randomly allocated to two groups for ventilation: LMA and rigid bronchoscopy. Vital signs, including blood pressure, heart rate and percentage of blood O2 saturation before and during the procedure, degree of sore throat after recovery and physician's satisfaction, were recorded. Results: A total of 83 patients, including 45 in the "LMA" and 38 in the "rigid" groups, were enrolled in this study. Their mean age was 51±17 years, and 59 (71%) were male. There was a statically significant difference between "rigid" and "LMA" categories regarding the decrease in O2 during the procedure in proportion to baseline figures (p=0.028). Haemodynamic parameters were better maintained using LMA compared to rigid bronchoscopy. Conclusion: Laryngeal mask ventilation maintains better oxygenation and haemodynamic stability and ensures physicians' and patients' satisfaction regarding ease of use, airway access and fewer complications compared to rigid bronchoscopy. Therefore, LMA can be introduced as a reliable alternative for ventilation during interventional airway procedures.
Conference Paper
Introduction: Myasthenic crisis (MC) is often associated with prolonged intubation and with respiratory complications. This study aims to assess predictors of ventilation duration and to compare the effectiveness of endotracheal intubation and mechanical ventilation (ET-MV) with bilevel positive airway pressure (BiPAP) noninvasive ventilation in MC. Methods: We reviewed consecutive episodes of MC treated at Masih Daneshvari Medical Center. Collected information included patients' demographic data, immunotherapy, medical complications, mechanical ventilation duration, and hospital lengths of stay, as well as baseline and preventilation measurements of forced vital capacity, maximal inspiratory and expiratory pressures, and arterial blood gases. Results: We identified 60 episodes of MC in 52 patients. BiPAP was the initial method of ventilatory support in 24 episodes and ET-MV was performed in 36 episodes. There were no differences in patient demographics or in baseline respiratory variables and arterial gases between the groups of episodes initially treated using Bi- PAP vs ET-MV. In 14 episodes treated using BiPAP, intubation was avoided. The mean duration of BiPAP in these patients was 4.3 days. The only predictor of BiPAP failure (ie, requirement for intubation) was a PCO2 level exceeding 45 mm Hg on BiPAP initiation (P=.04). The mean ventilation duration was 10.4 days. Longer ventilation duration was associated with intubation (P=.02), atelectasis (P_.005), and lowermaximal expiratory pressure on arrival (P=.02). The intensive care unit and hospital lengths of stay statistically significantly increased with ventilation duration (P_.001 for both). The only variable associated with decreased ventilation duration was initial BiPAP treatment (P_.007). Conclusions: BiPAP is effective for the treatment of acute respiratory failure in patients with myasthenia gravis. A BiPAP trial before the development of hypercapnia can prevent intubation and prolonged ventilation, reducing pulmonary complications and lengths of intensive care unit and hospital stay.