A pilot study of respiratory inductance plethysmography as a safe, noninvasive detector of jet ventilation under general anesthesia.
BACKGROUND
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.


METHODS
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.


RESULTS
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.


CONCLUSIONS
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.
Atkins
Joshua H
JH
Department of Anesthesiology and Critical Care, University of Pennsylvania School of Medicine, Philadelphia, PA 19104, USA. Joshua.Atkins@uphs.upenn.edu
Mandel
Jeff E
JE
Weinstein
Gregory S
GS
Mirza
Natasha
N
D000768:Anesthesia, General; D005240:Feasibility Studies; D006611:High-Frequency Jet Ventilation; D006801:Humans; D007828:Laryngoscopy; D016343:Monitoring, Intraoperative / Q000379:methods*; D015143:Philadelphia; D010865:Pilot Projects; D010991:Plethysmography; D011237:Predictive Value of Tests; D012123:Pulmonary Ventilation; D012680:Sensitivity and Specificity; D012815:Signal Processing, Computer-Assisted; D013997:Time Factors