0
Clinical Investigations: TECHNIQUES |

Negative Pressure Ventilation vs External High-Frequency Oscillation During Rigid Bronchoscopy*: A Controlled Randomized Trial

Giuseppe Natalini, MD; Sergio Cavaliere, MD; Veronica Seramondi, MD; Pierfranco Foccoli, MD; Michele Vitacca, MD; Nicolino Ambrosino, MD, FCCP; Andrea Candiani, MD
Author and Funding Information

*From the Department of Anesthesia and Intensive Care (Drs. Natalini, Seramondi, and Candiani), University of Brescia; the Respiratory Endoscopy and Laser-Therapy Center (Drs. Cavaliere and Foccoli), Spedali Civili Brescia; and the Lung Function Unit (Drs. Vitacca and Ambrosino), S. Maugeri Foundation IRCCS, Gussago, Italy.

Correspondence to: Giuseppe Natalini, MD, Terapia Intensiva Polifunzionale, Casa di Cura “Poliambulanza”, Via Bissolati 57, 25124 Brescia, Italy; e-mail:newpoli@tin.it.



Chest. 2000;118(1):18-23. doi:10.1378/chest.118.1.18
Text Size: A A A
Published online

Study objectives: To compare the effectiveness of two modalities of external ventilation during rigid bronchoscopy: intermittent negative pressure ventilation (INPV) and external high-frequency oscillation (EHFO).

Design: Prospective, controlled, randomized, nonblinded study.

Setting: University-affiliated hospital.

Patients: Seventy patients undergoing interventional rigid bronchoscopy for tracheobronchial lesions were enrolled into the study.

Interventions: Mechanical ventilation was performed by INPV or EHFO. When pulse oximetry was < 90%, manually assisted ventilation was delivered.

Measurements and results: Arterial blood gases were sampled preoperatively and intraoperatively. Most patients in both groups had normal intraoperative Paco2 (mean, 43.6 ± 11.8 mm Hg under EHFO and 37.4 ± 8.2 mm Hg under INPV; p = 0.012), and acidemia occurred in 9 of 35 patients of EHFO group and in 2 of 35 patients of INPV group (p = 0.049). Hypercapnia (Paco2 > 50 mm Hg) was observed in 10 patients under EHFO and in 2 with INPV (p = 0.026). Intraoperative mean Pao2 was similar (101.4 ± 52.9 mm Hg with EHFO and 124.2 ± 50.3 mm Hg with INPV; p = 0.07), but O2 supply was different (3.5 ± 2.3 L/min during INPV and 8.5 ± 6.2 L/min during EHFO; p < 0.001). Intraoperative hypoxemia (Pao2 < 60 mm Hg) occurred in five patients with EHFO and two with INPV (p = 0.426). Three EHFO patients required manually assisted ventilation (mean, 0.2 ± 0.9), but no INPV patient did (p = 0.142).

Conclusions: External negative pressure ventilation appears to be a suitable choice during rigid bronchoscopy: both EHFO and INPV ensure effective ventilation and comfortable operating conditions in the majority of patients. Some patients may receive inadequate ventilation with EHFO, developing respiratory acidosis and requiring manually assisted ventilation. In comparison with INPV, EHFO requires a higher fraction of inspired oxygen.

Figures in this Article

Sign In to Access Full Content

MEMBER & INDIVIDUAL SUBSCRIBER

Want Access?

NEW TO CHEST?

Become a CHEST member and receive a FREE subscription as a benefit of membership.

Individuals can purchase this article on ScienceDirect.

Individuals can purchase a subscription to the journal.

Individuals can purchase a subscription to the journal or buy individual articles.

Learn more about membership or Purchase a Full Subscription.

INSTITUTIONAL ACCESS

Institutional access is now available through ScienceDirect and can be purchased at myelsevier.com.

Sign In to Access Full Content

MEMBER & INDIVIDUAL SUBSCRIBER

Want Access?

NEW TO CHEST?

Become a CHEST member and receive a FREE subscription as a benefit of membership.

Individuals can purchase this article on ScienceDirect.

Individuals can purchase a subscription to the journal.

Individuals can purchase a subscription to the journal or buy individual articles.

Learn more about membership or Purchase a Full Subscription.

INSTITUTIONAL ACCESS

Institutional access is now available through ScienceDirect and can be purchased at myelsevier.com.

Figures

Tables

References

NOTE:
Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).

Some tools below are only available to our subscribers or users with an online account.

Sign In to Access Full Content

MEMBER & INDIVIDUAL SUBSCRIBER

Want Access?

NEW TO CHEST?

Become a CHEST member and receive a FREE subscription as a benefit of membership.

Individuals can purchase this article on ScienceDirect.

Individuals can purchase a subscription to the journal.

Individuals can purchase a subscription to the journal or buy individual articles.

Learn more about membership or Purchase a Full Subscription.

INSTITUTIONAL ACCESS

Institutional access is now available through ScienceDirect and can be purchased at myelsevier.com.

Related Content

Customize your page view by dragging & repositioning the boxes below.

Find Similar Articles
CHEST Journal Articles
  • CHEST Journal
    Print ISSN: 0012-3692
    Online ISSN: 1931-3543