Clinical efficacy of high frequency jet ventilation during extracorporeal shock wave lithotripsy of renal and ureteral calculi: a comparison with conventional mechanical ventilation.

The use of high frequency jet ventilation compared to conventional mechanical ventilation during general anesthesia for extracorporeal shock wave lithotripsy of renal or ureteral calculi can reduce stone movement. This decrease in stone movement theoretically lessens the total shock and energy requirements for stone fragmentation and perirenal tissue damage. To assess these theoretical advantages of high frequency jet ventilation, we studied patients undergoing extracorporeal shock wave lithotripsy to determine differences in stone movement during high frequency jet and conventional mechanical ventilation (30 patients), and in total shock requirements (1,174 patients). Mean stone movement in the 30 patients was 34.3 +/- 4.3 mm. during conventional mechanical ventilation compared to 4.1 +/- 1.9 mm. during high frequency jet ventilation (p less than 0.001). Mean total shocks were 1,542 +/- 212 (452 patients) during conventional mechanical ventilation compared to 1,217 +/- 165 (722 patients) during high frequency jet ventilation (p less than 0.001). Only 1 patient in the study had clinically significant perirenal tissue damage. We conclude that high frequency jet ventilation when compared to conventional mechanical ventilation results in clinically and economically beneficial decreases in total shocks for extracorporeal shock wave lithotripsy fragmentation of renal or ureteral calculi.