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High Frequency Ventilation and Atrial Fibrillation Ablation

Weiner, Menachem M. MD

doi: 10.1213/ANE.0b013e31822c120c
Letters to the Editor: Letters & Announcements

Department of Anesthesiology Mount Sinai Medical Center New York, New York (Weiner)

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To the Editor

The novel use of high frequency jet ventilation (HFJV) in the electrophysiology suite during atrial fibrillation ablations was recently described by Raiten et al.1 Two points deserve mention.

First, the authors describe the technique whereby the jet ventilator tubing is attached directly to the endotracheal tube. However, this will not allow for monitoring of distal airway pressures, leading to the risk of barotrauma. HFJV can cause gas trapping, which can increase alveolar and distal tracheal pressure without affecting proximal airway pressure.2 This pressure difference is referred to as intrinsic positive end-expiratory pressure (PEEP) or auto-PEEP. In our early experience, we had several instances of high airway pressures caused by the development of auto-PEEP. It is therefore recommended to measure airway pressures as far distally in the trachea as possible.3 Our standard technique involves the use of the swivel connector with jet catheter (Acutronic Medical Systems, Fabrik im Schiffli, Switzerland), a 2-lumen device with 1 lumen serving as the jet outlet allowing us to deliver HFJV and 1 longer lumen positioned in the distal trachea to measure distal airway pressures.

Second, and in contrast to the comment that only 2 centers routinely use the technique, we have performed HFJV for about 125 patients undergoing ablation for atrial fibrillation.

Menachem M. Weiner, MD

Department of Anesthesiology

Mount Sinai Medical Center

New York, New York

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1. Raiten J, Elkassabany N, Gao W, Mandel JE. Novel uses of high frequency jet ventilation outside the operating room. Anesth Analg 2011;112:1110–3
2. Beamer WC, Prough DS, Royster RL, Johnston WE, Johnson JC. High-frequency jet ventilation produces auto-PEEP. Crit Care Med 1984;12:734–7
3. Waterson CK, Militzer HW, Quan SF, Calkins JM. Airway pressure as a measure of gas exchange during high frequency jet ventilation. Crit Care Med 1984;12:742–6
© 2011 International Anesthesia Research Society