The management of air leaksa lowpressure approach

HFJV has been used in the management of bronchopleural fistula for many years. At low pressure, HFJV is thought to decrease gas flow through the fistula, enhancing the possibility of closure. Inspired gas distribution with HFJV is determined by airways resistance (rather than compliance); thus effective ventilation of lung units juxtaposed to an area of infinite compliance (i.e. a bronchopleural fistula), is possible. In this approach, the volume of gas pulses delivered is small. Peak and mean airway pressures are reduced to those which allow effective ventilation, while airflow through the bronchopleural fistula is minimized. This low-pressure philosophy does not invoke aggressive lung volume maintenance techniques or any attempt to generate intrinsic PEEP.

A similar low-pressure philosophy can be employed following tracheal trauma or reconstructive surgery. Ventilation without inflation of the endotracheal tube cuff is desirable following some tracheal surgical procedures and is most efficiently administered with the jet nozzle placed at the proximal end of the endotracheal tube. The technology can be modified to jet distal to surgical anastomoses via a catheter or a stomal airway such as a T-piece. HFJV has been described as the management of choice in traumatic tracheal rupture or following its surgical repair ( Brimio.u.l.le.,et.al 1990).

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