We report three complicated cases of open-chest surgery in which volume-controlled high-frequency positive-pressure ventilation (HFPPV) was used because the low airway pressures and reduced intra-operative lung movement associated with this type of ventilation were considered desirable. The Siemens-Elema Bronchovent® Special ventilator was used at a frequency of 60/min, with inspiratory time occupying 22% of the ventilatory cycle. Ventilation (judged by Paco2) was regulated by ventilator gas output (10-18 l/min), providing tidal volumes of 167 to 300 ml. Arterial oxygenation (judged by Pao2) was adjusted by means of the inspired oxygen fraction (0.40-0.60) of the anesthetic gas mixture delivered by the ventilator. The cases reported are those of (1) a 61-year-old man requiring surgical resection of a thoracic aortic aneurysm, (2) a 61-year-old man requiring right-sided pneumonectomy for carcinoma, and (3) a 46-year-old man requiring repair of a bronchial fistula. HFPPV provided a favorable operating field and acceptable-to-good ventilation and oxygenation in all cases. All three patients were able to be extubated immediately following surgery.
MalinaJR, NordströmSG, SjöstrandUH, WattwilLM. Clinical evaluation of high-frequency positive-pressure ventilation (HFPPV) in patients scheduled for open-chest surgery. Anesth Analg1981;60:324–330.
2.
SjöstrandU.Pneumatic systems facilitating treatment of respiratory insufficiency with alternative use of IPPV/PEEP, HFPPV/PEEP, CPPB, or CPAP. Acta Anaesthesiol Scand [Suppl]1977;64:123–147.
3.
SjöstrandU.High-frequency positive-pressure ventilation (HFPPV): A review. Crit Care Med1980;8:345–364.
4.
BorgU, ErikssonI, SjöstrandU.High-frequency positive-pressure ventilation (HFPPV): A review based upon its use during bronchoscopy and for laryngoscopy and microlaryngeal surgery under general anesthesia. Anesth Analg1980;59:594–603.
5.
ErikssonI, NilssonL-G, NordströmS, SjöstrandU.High-frequency positive-pressure ventilation (HFPPV) during transthoracic resection of tracheal stenosis and during peroperative bronchoscopic examination. Acta Anaesthesiol Scand1975;19:113–119.
6.
El-BazN, El-GanzouriA, GottschalkW, JensikR.One-lung high-frequency positive pressure ventilation for sleeve pneumonectomy: An alternative technique. Anesth Analg1981;60:683–686.
7.
NilssonE, SlaterEM, GreenbergJ.The cost of the quiet lung: Fluctuations in Pao2 when the Carlens tube is used in pulmonary surgery. Acta Anaesthesiol Scand1965;9:49–55.
8.
AlferyDD, BenumofJL, TrousdaleFR. Improving oxygenation during one-lung ventilation in dogs: The effects of positive end-expiratory pressure and blood flow restriction to the nonventilated lung. Anesthesiology1981;55:381–385.
9.
CarlonG, RayCJr, KlainM, McCormackPM. High-frequency positive-pressure ventilation in management of a patient with bronchopleural fistula. Anesthesiology1980;52:160–162.
10.
CarlonGC, KahnRC, HowlandWS, RayCJr, TurnbullAD. Clinical experience with high-frequency jet ventilation. Crit Care Med1981;9:1–6.
11.
ErikssonI, SjöstrandU.Experimental and clinical evaluation of high-frequency positive-pressure ventilation (HFPPV) and the pneumatic valve principle in bronchoscopy under general anaesthesia. Acta Anaesthesiol Scand [Suppl]1977;64:83–100.
12.
WattwilLM, SjöstrandUH, BorgUR. Comparative studies of IPPV and HFPPV with PEEP in critical care patients-A clinical evaluation. Crit Care Med (in press).
13.
SmithRB, HoffBH, RosenL, WilsonE, SwartzmanS.High frequency ventilation during pulmonary lobectomy-Three cases. Respir Care1981;26:437–441.
