Hugo Keszler’s research while affiliated with University of Pittsburgh and other places

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Publications (21)


INTRAPULMONARY DRUG APPLICATION FOR CARDIOPULMONARLY RESUSCITATION
  • Article

September 1992

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10 Reads

Anesthesiology

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H. Keszler

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[...]

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P. Safar


High-Frequency Jet Ventilation

September 1985

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10 Reads

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24 Citations

Surgical Clinics of North America

High-frequency jet ventilation is a useful new modality of ventilatory support that offers specific advantage in endoscopy, laryngeal surgery, or mechanically ventilating patients with airway leaks. The method produces lower airway pressures and less movement in the operative field and is well tolerated by the patients. It can be applied by transtracheal puncture as an alternative for emergency airway management.


High Frequency Jet Ventilation Prevents Aspiration during Cardiopulmonary Resuscitation

January 1985

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6 Reads

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1 Citation

Prehospital and disaster medicine: the official journal of the National Association of EMS Physicians and the World Association for Emergency and Disaster Medicine in association with the Acute Care Foundation

Ventilation is an integral part of cardiopulmonary resuscitation (CPR). Early intubation is recommended not only for the sake of better ventilation but also to prevent aspiration since aspiration is a common occurrence during CPR. It probably not infrequently contributes to an unfavorable outcome. Endotracheal intubation is sometimes very difficult especially under field conditions. Cricothyroid membrane puncture or transtracheal puncture with a 14g or 16g catheter needle enables high frequency jet ventilation (HFJV) and can often be performed more easily than intubation.


Intrapulmonary Drug Administration during High Frequency Jet Ventilation

January 1985

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4 Reads

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2 Citations

Prehospital and disaster medicine: the official journal of the National Association of EMS Physicians and the World Association for Emergency and Disaster Medicine in association with the Acute Care Foundation

It has previously been demonstrated that high frequency jet ventilation, via transtracheal cricothyroid membrane puncture, can maintain good gas exchange even during cardiopulmonary resuscitation. When the upper airways were filled with fluid, aspiration could be prevented without a cuffed endotracheal tube when respiratory rates of 100/min or higher and an inspiratory time of at least 50% were used. We have also shown that cricothyroid membrane puncture is relatively easy to perform and produces less tracheal damage than a cuffed endotracheal tube. In one of our studies, cardio-green dye was mixed into the jet using a Y-connector on the proximal end of the angiocath cannula (Figure 1). In two dogs, the distribution of the dye in the lungs was investigated. It was found that nebulized dye was transported by the jet stream to the most distant bronchi which could be observed. On subsequent autopsy, the dye was found in the most peripheral airways.


Transtracheal High Frequency Jet Ventilation Prevents Aspiration

April 1983

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18 Reads

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36 Citations

Critical Care Medicine

Aspiration is a potentially fatal complication of artificial ventilation. A cuffed tube is generally used now to prevent aspiration; however, it may lead to serious complications and has several disadvantages. High frequency jet ventilation (HFJV) is an innovative technique to prevent aspiration. The trachea of 6 anesthetized, paralyzed dogs was exposed and a catheter for jet ventilation introduced between the 1st and 2nd tracheal ring. Another catheter was used for measuring intratracheal pressure. An endoscope was inserted into the trachea about 2 inches lower down and directed upwards to give a view of the vocal cords from below. A mixture of saliva, saline, and cardiogreen was introduced into the mouth so as to form a pool. When observation confirmed that HFJV prevents aspiration at frequencies of 100/min and ratios of inspiration/expiration (I:E) equalling 1:1, observations were repeated at I:E, 1:2 and 1:3 and at rates of 60/min and 200/min. The depth of the pool was gradually increased to between 2 and 31/4 inches and observations were repeated. Endoscopy alone was used in 4 animals and endoscopic film in 2 to evaluate the efficacy of HFJV. The results showed convincingly that: (1) HFJV can prevent fluid from entering the larynx from above; (2) this effect is unreliable when the frequency is decreased to 60/min or inspiration becomes shorter than 33% of the cycle; (3) intratracheal end-expiratory pressures show values slightly higher than the fluid level above the cords; and (4) the cords are separated and the gas mixture bubbles through the fluid. We conclude that (a) valve mechanisms cannot account for our observations; and (b) at rates above 60/min and with duration of expiration of 66% or less, HFJV will prevent aspiration by causing a continuous gas flow outward through the larynx. This is associated with a low continuous positive airway pressure and excellent blood gases.


Clinical Experience with High Frequency Ventilation

January 1983

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5 Reads

Indications for clinical application of high frequency ventilation (HFV) are given by the basic characteristics of the method (1). High frequency ventilation is capable to achieve a good gas exchange with small tidal volumes. Resulting low airway pressures and low intrathoracic pressures decrease the incidence of two main side effects of positive pressure ventilation, namely barotrauma and circulatory depression. Therefore, barotrauma or prevention of barotrauma and prevention of circulatory depression are the two main indications for high frequency ventilation.


What is the Role of Transtracheal Ventilation in Emergency and Long-Term Respiratory Support?

January 1983

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1 Read

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1 Citation

High frequency jet ventilation (HFJV) is capable of providing total respiratory support through a 14 gauge catheter introduced by cricothyroid membrane puncture (1). This method offers distinct advantages for emergency use. It can be performed even in conscious patients under local anesthesia without muscle paralysis. In such a way sometimes traumatic attempts at intubation in emergency situations can be avoided and the need for extensive neck hyperextension eliminated. Because cricothyroid membrane puncture is usually easy we can secure the airway in a short time.




Citations (8)


... High-frequency jet ventilation (HFJV) has proved to be an alternative to conventional mechanical ventilation (CMV) [1][2][3][4]. The major advantage of HFJV lies in the improvement of the mucociliary transport system [5], the recruitment of atelectatic areas [6], and the improvement of oxygenation [7,8], maintaining very low tidal volumes to avoid lung barotrauma [9]. ...

Reference:

A new prototype of an electronic jet-ventilator and its humidification system
Electron-microscopic studies of tracheal mucosa after high frequency jet ventilation.
  • Citing Article
  • March 1982

Critical Care Medicine

... We report a case of intracardiac epinephrine injection during open thoracotomy and pulseless electrical activity that resulted in return of cardiac function. Successful intracardiac injection of stimulants was first reported in 1922 in patients under chloroform anesthesia who sustained circulatory arrest [1]. Shortly after, dozens of additional case reports arose including the use of 1 mL of 1:1000 epinephrine injected directly into the ventricle as a last resort in a patient with syphilitic coronary arteritis [2]. ...

Intracardiac Injections During Resuscitation
  • Citing Article
  • July 1981

JAMA The Journal of the American Medical Association

... High-frequency jet ventilation (HFJV) has proved to be an alternative to conventional mechanical ventilation (CMV) [1][2][3][4]. The major advantage of HFJV lies in the improvement of the mucociliary transport system [5], the recruitment of atelectatic areas [6], and the improvement of oxygenation [7,8], maintaining very low tidal volumes to avoid lung barotrauma [9]. However, one of the critical issues concerning HFJV is the adequate humidification and warming of the inspired gases [10]. ...

How Does High Frequency Jet Ventilation Effect the Mucociliary Transport?
  • Citing Article
  • March 1981

Critical Care Medicine

... To improve the surgical conditions of the upper airway, high-frequency jet ventilation (HFJV) has been used since the 1980s, where high-capacity humidified oxygen-mixed air is regularly injected into a thin plastic cannula [15,16]. Compared to endotracheal intubation, the HFJV provides the surgeon with superior accessibility to the posterior part of the larynx with a wider view [17]. However, the technique has several disadvantages. ...

High-Frequency Jet Ventilation
  • Citing Article
  • September 1985

Surgical Clinics of North America

... JV could provide a good ex posure of the larynx, trachea (18). One of the most important advantages of this method of ventilation is an effective gas transport without high airway pressure (18), elimination of the need for laryngos copy to secure the airway (19). Aspiration of gastric contents is prevented by causing a continuous gas flow outward through the larynx (20). ...

Transtracheal High Frequency Jet Ventilation Prevents Aspiration
  • Citing Article
  • April 1983

Critical Care Medicine

... This closed system was compared with conventional open tracheal suctioning; deterioration in Pa Oj occurred only during open suctioning in patients receiving more than lOcmHjO of PEEP. The advantage of avoiding ventilator disconnection during tracheal suctioning was shown to be one of the benefits of jet ventilation [29], and a valve attachment for tracheal tubes was designed allowing suction without interruption of conventional ventilation [5]-Therefore, PDPV, tracheal suctioning and ventilator disconnection may contribute to the short term hypoxaemia occurring in many critically ill patients following chest physiotherapy. The most likely mechanism for this hypoxaemia is atelectasis, although stimulation of the patient causing increased oxygen extraction may also be a factor. ...

Tracheobronchial toilet without cardiorespiratory impairment
  • Citing Article
  • June 1980

Critical Care Medicine

... A useful alternative to manual CPR might be the combination of MCCD in continuous mode with passive ventilation [15]. Previous studies have examined the hypothesis that automatic ventilation with high frequency and low airway pressure may benefit CPR outcomes [16], [17], [18], [19]. Klain et al. [16] described high-frequency jet ventilation during CPR, administering 100-500 breaths per minute through percutaneous cannulation of the trachea. ...

'High Frequency Jet Ventilation in CPR
  • Citing Article
  • June 1981

Critical Care Medicine