J Cancer 2018; 9(5):816-833. doi:10.7150/jca.23737

Research Paper

A New and Safe Mode of Ventilation for Interventional Pulmonary Medicine: The Ease of Nasal Superimposed High Frequency Jet Ventilation

Wolfgang Hohenforst-Schmidt1, Paul Zarogoulidis2✉, Haidong Huang3, Yan-Gao Man4, Stella Laskou, Charilaos Koulouris, Dimitris Giannakidis, Stylianos Mantalobas, Maria C. Florou5, Aikaterini Amaniti6, Michael Steinheimer1, Anil Sinha1, Lutz Freitag7, J Francis Turner8, Robert Browning9, Thomas Vogl10, Andrei Roman10, Naim Benhassen11, Isaak Kesisoglou5, Konstantinos Sapalidis5

1. Sana Clinic Group Franken, Department of Cardiology / Pulmonology / Intensive Care / Nephrology, ''Hof'' Clinics, University of Erlangen, Hof, Germany
2. Pulmonary-Oncology Department, ``Theageneio`` Cancer Hospital, Thessaloniki, Greece
3. Department of Respiratory Diseases Shanghai Hospital, II Military University Hospital, Shanghai, People's Republic of China.
4. Research Laboratory and International Collaboration, Bon Secours Cancer Institute, VA, USA
5. 3rd Department of Surgery, “AHEPA” University Hospital, Aristotle University of Thessaloniki, Medical School, Thessaloniki, Greece
6. Anesthesiology Department, “AHEPA” University General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
7. Department of Interventional Pneumology, Ruhrlandklinik, University Hospital Essen, University of Essen-Duisburg, Tueschener Weg 40, 45239 Essen, Germany.
8. Division of Interventional Pulmonology & Medical Oncology, Cancer Treatment Centers of America, Western Regional Medical Center, Goodyear, AZ.
9. Pulmonary & Critical Care Medicine, Interventional Pulmonology, National Naval Medical Center, Walter Reed Army Medical Center, Bethesda, U.S.A.
10. Department of Diagnostic and Interventional Radiology, Goethe University of Frankfurt, Frankfurt, Germany.
11. Medical Clinic I, "Fuerth" Hospital, University of Erlangen, Fuerth, Germany.


We use pulmonary interventional procedures for the diagnosis of pulmonary diseases either for benign or malignant lesions. Flexible bronchoscopy with or without radial endobronchial ultrasound, convex-probe endobronchial ultrasound and electromagnetic navigation are procedures performed in centers with experience in diagnostic pulmonary medicine. The method of sedation and ventilation is very important in order to avoid or handle with success complications. Proper respiration during pulmonary (or other interventional) procedures is a key factor. Apart from the proper sedation method we have to choose the proper ventilation method which decides respiratory movement. Superimposed high-frequency jet ventilation (SHFJV) is supposed to be safe and effective in clinical practice. Although this perception is commonly accepted, there is no study proving its safety on the basic of reliable data. We analyzed the data of 100 patients in different interventional settings (bronchoscopy with or without navigational approach, left atrial appendage closure (LAAC) or intracardiac catheterization) using nasal SHFJV. Mainly analyzed were capillary ABG-Data at the beginning and end of the intervention under sedation. The aim was to analyze if a risk scenario for the patient by using the nasal SHFJV can be derived by measuring the changes of pCO2, pO2, cBase Excess, cHCO3 and PH. Due to our data we conclude that this method of ventilation can be easily and safely used in interventional medicine for patients with all kind of comorbidities such as; chronic respiratory disease, lung cancer, interstitial lung disease, structural heart disease and heart failure.

Keywords: lung cancer, bronchoscopy, endobronchial navigation, endobronchial ultrasound, interventional medicine, minimal-invasive techniques, conebeam computertomography, jet-ventilation.

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How to cite this article:
Hohenforst-Schmidt W, Zarogoulidis P, Huang H, Man YG, Laskou S, Koulouris C, Giannakidis D, Mantalobas S, Florou MC, Amaniti A, Steinheimer M, Sinha A, Freitag L, Turner JF, Browning R, Vogl T, Roman A, Benhassen N, Kesisoglou I, Sapalidis K. A New and Safe Mode of Ventilation for Interventional Pulmonary Medicine: The Ease of Nasal Superimposed High Frequency Jet Ventilation. J Cancer 2018; 9(5):816-833. doi:10.7150/jca.23737. Available from http://www.jcancer.org/v09p0816.htm