Alternative Ventilatory Techniques

  • Gyorgy Frendl


Most patients undergoing thoracic surgical procedures suffer from some degree of pulmonary disease which impacts their ventilatory management. Traditional modes of positive pressure mechanical ventilation are familiar to the general practitioner (Box 11-1) (Fig 11-1) and have been well reviewed (1). Variations on these common modes, dictated by pathophysiology (e.g., longer expiratory time for obstructive pulmonary disease, etc.) should also be familiar (2). The focus of this chapter will be alternative ventilatory techniques that may be necessary during specific thoracic surgical procedures or situations, when traditional ventilatory techniques are inadequate. Such alternative techniques (e.g., jet ventilation, high frequency ventilation (HFV), etc.) may be used as the primary mode of ventilation, or as an adjunct in various thoracic surgical situations.


Ventilatory management Alternative ventilatory techniques Jet ventilation Bernoulli’s Principle Venturi Effect High frequency ventilation High frequency positive pressure ventilation High frequency jet ventilation High frequency oscillatory ventilation High frequency flow interruption Apneic insufflation Differential ventilation Noninvasive positive pressure ventilation 

Selected References

  1. 1.
    Tobin MJ, editor. Principles and practice of mechanical ventilation. New York: McGraw-Hill; 2006.Google Scholar
  2. 2.
    Lumb AB, editor. Nunn’s: applied respiratory physiology. Philadelphia: Butterworth & Heinemannn; 2000.Google Scholar
  3. 3.
    The Acute Respiratory Distress Syndrome Network. Ventilation with lower tidal volumes as compared with traditional tidal volumes for acute lung injury and the acute respiratory distress syndrome. N Engl J Med. 2000;342:1301–8.CrossRefGoogle Scholar
  4. 4.
    Benumof JL, editor. Anesthesia for thoracic surgery. Philadelphia: WB Saunders; 1995.Google Scholar

Further Suggested Reading

  1. Kaplan JA, Slinger PD, editors. Thoracic anesthesia. Churchill-Livingston: Elsevier Science; 2003.Google Scholar
  2. Ritacca FV, Stewart TE. Clinical review: high-frequency oscillatory ventilation in adults – a review of the literature and practical applications. Crit Care. 2003;7:385–90.PubMedCrossRefGoogle Scholar
  3. Hess D, Mason S, Branson R. High frequency ventilation. Respir Care Clin North Am. 2001;7:577–98.CrossRefGoogle Scholar
  4. MacIntyre NR. High frequency jet ventilation. Respir Care Clin North Am. 2001;7:599–610.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2012

Authors and Affiliations

  • Gyorgy Frendl
    • 1
  1. 1.Thoracic Anaesthesiologist and Intensivist Department of Anaesthesiology, Perioperative and Pain MedicineBrigham and Women’s HospitalBostonUSA

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