Department of Anesthesiology and Critical Care, University of Pennsylvania School of Medicine, Philadelphia, PA 19104, USA.
Anesth Analg. 2010 Nov;111(5):1168-75. doi: 10.1213/ANE.0b013e3181f10982. Epub 2010 Aug 24.
High-frequency jet ventilation is an optimal mode of ventilation for many surgical procedures of the trachea and larynx but has limited monitoring modalities to assess adequacy of oxygenation and/or ventilation. Respiratory inductance plethysmography is a noninvasive monitor of chest and abdominal wall movement with well-established applications in the sleep laboratory. We performed an observational pilot study of respiratory inductance plethysmography as a detector of jet ventilation.
Twenty-five patients underwent microdirect suspension laryngoscopy with high-frequency jet ventilation under general anesthesia with total IV anesthesia. Inductotrace® bands (Ambulatory Monitoring Inc., Ardsley, NY) were applied to the chest and abdomen in all patients and data collected from oxygen administration through emergence at 50-Hz sampling frequency in the DC mode using a 12-bit A-D converter and custom programmed LabVIEW interface. The raw data were filtered and a detector was developed based on a type I, IIR peak comb filter to differentiate apnea, cardiogenic oscillations, and jet ventilation- associated respiratory excursion. The primary end point was the ability of the detector to identify the presence of jet ventilation. Receiver operating characteristic curves were generated for the aggregate data of all patients.
Respiratory inductance plethysmography reliably detected jet ventilation. The data analysis program effectively extracted a relatively small amplitude jet ventilation signal from a baseline signal contaminated by cardiogenic noise. Sensitivity was in the range of 85%, with a filter bandwidth of 0.055 Hz. Increased sensitivity with increasing filter bandwidth was offset by a detection delay of 12.5 seconds.
Respiratory inductance plethysmography was successfully used to detect high-frequency jet ventilation in patients undergoing laryngotracheal surgery. This pilot study demonstrates the feasibility of respiratory inductance plethysmography as a monitor for use during jet ventilation.
高频喷射通气是气管和喉外科许多手术的最佳通气模式，但对氧合和/或通气的充分性评估的监测方式有限。呼吸感应体积描记法是一种无创监测胸腹壁运动的方法，在睡眠实验室中得到了广泛的应用。我们进行了一项关于呼吸感应体积描记法作为喷射通气探测器的观察性初步研究。
25 名患者在全身麻醉下接受高频喷射通气的微直接悬雍垂切除术，其中全静脉麻醉。所有患者均在胸部和腹部应用 Inductotrace®带（Ardsley，NY 的 Ambulatory Monitoring Inc.），并在 50-Hz 采样频率的 DC 模式下使用 12 位 A-D 转换器和定制的 LabVIEW 接口从给氧到苏醒期间收集数据。原始数据进行滤波，并开发了一种基于 I 型、IIR 峰值梳状滤波器的探测器，以区分呼吸暂停、心源性振荡和喷射通气相关的呼吸波动。主要终点是探测器识别喷射通气的能力。为所有患者的汇总数据生成了接收者操作特征曲线。
呼吸感应体积描记法可靠地检测到喷射通气。数据分析程序有效地从基线信号中提取出一个相对较小幅度的喷射通气信号，该信号受到心源性噪声的污染。灵敏度在 85%的范围内，滤波器带宽为 0.055 Hz。随着滤波器带宽的增加，灵敏度增加，但检测延迟为 12.5 秒。
呼吸感应体积描记法成功地用于检测接受喉气管手术的患者的高频喷射通气。这项初步研究证明了呼吸感应体积描记法作为喷射通气期间使用的监测器的可行性。
