Ihra G, Kepka A, Lanzenberger E, Donner A, Schabernig C, Zimpfer M, Aloy A
Klinik für Anästhesiologie und Allgemeine Intensivmedizin der Universität Wien.
Anaesthesist. 1998 Mar;47(3):209-19. doi: 10.1007/s001010050549.
Despite advances and technical developments in the area of intensive care medicine it has not been possible to lower the mortality of patients with pulmonary insufficiency. Therefore, alternative ventilation strategies have been developed and applied. One of these ventilation techniques is superimposed high-frequency jet ventilation (SHFJV). For optimal application of SHFJV we designed a special jet-adapter.
This jet-adapter made of plastic consists of a T-piece and four central, small-bore cannulas and can be connected to any commercially available endotracheal tube. Therefore, it does not require reintubation with an endotracheal jet tube when beginning SHFJV. The simultaneous high-frequency and low-frequency jet ventilation is performed over two jet-nozzles that have been designed according to optimal flow dynamic measurements. Two further cannulas are used for continuous airway pressure monitoring and humidification of the applied gases. A pre-warmed and humidified bias flow with exactly defined oxygen concentration is led through the cross-part of the T-piece for gas entrainment. Additionally, the cross-part contains a port that can be opened for endotracheal suctioning or bronchoscopy and makes disconnection of the jet adapter from the endotracheal tube for either purpose unnecessary.
The jet adapter can be used: (1) to apply SHFJV; (2) to measure airway pressures continuously; (3) to humidify and warm inspired gases; (4) to administer medications or add nitrous oxide by the inspiratory route, enabling combination with new therapeutic possibilities in the management of patients with severe ARDS.
尽管重症监护医学领域取得了进展和技术发展，但仍无法降低肺功能不全患者的死亡率。因此，已开发并应用了替代通气策略。其中一种通气技术是叠加高频喷射通气（SHFJV）。为了实现SHFJV的最佳应用，我们设计了一种特殊的喷射适配器。
这种由塑料制成的喷射适配器由一个三通管和四个中央小口径插管组成，可连接到任何市售的气管内导管。因此，开始进行SHFJV时无需使用气管内喷射管重新插管。通过根据最佳流动动力学测量设计的两个喷射喷嘴进行同步高频和低频喷射通气。另外两个插管用于持续气道压力监测和所输送气体的加湿。一股预先加热和加湿、氧浓度精确界定的偏流通过三通管的交叉部分以实现气体夹带。此外，交叉部分有一个端口，可打开用于气管内吸痰或支气管镜检查，无需为任何目的将喷射适配器与气管内导管断开连接。
该喷射适配器可用于：（1）应用SHFJV；（2）持续测量气道压力；（3）加湿和加热吸入气体；（4）通过吸入途径给药或添加一氧化二氮，从而能够与重症急性呼吸窘迫综合征患者管理中的新治疗可能性相结合。
