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British Journal of Anaesthesia, 2000, Vol. 85, No. 3 462-465
© 2000 The Board of Management and Trustees of the British Journal of Anaesthesia

Influence of airway-occluding instruments on airway pressure during jet ventilation for rigid bronchoscopy

P. Biro*,1, M. Layer2, H. D. Becker3, F. Herth3, K. Wiedemann2, B. Seifert4 and D. R. Spahn1

1Institute of Anaesthesiology, University Hospital Zurich, CH-8091 Zurich, Switzerland. 2Department of Anaesthesiology and 3Section of Endoscopy, Thoraxklinik Heidelberg, D-69126 Heidelberg, Germany. 4Department of Biostatistics, University of Zurich, CH-8006 Zurich, Switzerland*Corresponding author

We measured changes in airway pressure (Paw) caused by microsurgical instruments introduced into a rigid bronchoscope during high frequency jet ventilation (HFJV). With approval of the institutional Ethics Committee, 10 adults undergoing elective tracheobronchial endoscopy and endosonography during general anaesthesia were investigated. Inflation of an endosonography probe balloon in the left main stem bronchus caused airway obstruction. Pressure measurements proximal and distal to the obstruction were compared after three degrees of obstruction (0%, 50% and 90%) and with two different driving pressure settings. Airway obstruction increased the mean (SD) peak inspiratory pressure (PIP) from 7.5 (2.6) to 9.5 (3.5) mm Hg for 2 atm (P=0.0008) and from 9.7 (3.7) to 13.0 (5.1) mm Hg for 3 atm (P=0.0001). Airway obstruction did not alter peripheral PIP (7.2 (4.1) to 7.1 (3.7) mm Hg for 2 atm and 8.8 (4.3) to 9.4 (5.2) mm for 3 atm), but resulted in an end-expiratory pressure (EEP) beyond the narrowing being significantly greater than in the unobstructed airway (2.5 (3.4) to 5.5 (3.7) mm Hg for 2 atm; P=0.0005) and 3.2 (3.6) to 8.0 (4.3) mm for 3 atm; P<0.0001). Severe airway narrowing increases inspiratory pressure proximal and expiratory pressure distal to the obstruction in relation to the applied driving pressure. Since the distal EEP never exceeded PIP, even near-total airway obstruction should not cause severe lung distension or barotrauma in subjects with normal lungs.

Br J Anaesth 2000; 85: 463–5


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