Use of High-Frequency Jet Ventilation for Percutaneous Tumor Ablation

Denys, Alban ; Lachenal, Yann ; Duran, Rafael ; Chollet-Rivier, Madeleine ; Bize, Pierre

In: CardioVascular and Interventional Radiology, 2014, vol. 37, no. 1, p. 140-146

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    Purpose: To report feasibility and potential benefits of high-frequency jet ventilation (HFJV) in tumor ablations techniques in liver, kidney, and lung lesions. Methods: This prospective study included 51 patients (14 women, mean age 66years) bearing 66 tumors (56 hepatic, 5 pulmonary, 5 renal tumors) with a median size of 16±8.7mm, referred for tumor ablation in an intention-to-treat fashion before preoperative anesthesiology visit. Cancellation and complications of HFJV were prospectively recorded. Anesthesia and procedure duration, as well as mean CO2 capnea, were recorded. When computed tomography guidance was used, 3D spacial coordinates of an anatomical target <2mm in diameter on 8 slabs of 4 slices of 3.75-mm slice thickness were registered. Results: HFJV was used in 41 of 51 patients. Of the ten patients who were not candidate for HFJV, two patients had contraindication to HFJV (severe COPD), three had lesions invisible under HFJV requiring deep inspiration apnea for tumor targeting, and five patients could not have HFJV because of unavailability of a trained anesthetic team. No specific complication or hypercapnia related to HFJV were observed despite a mean anesthetic duration of 2h and ventilation performed in procubitus (n=4) or lateral decubitus (n=6). Measured internal target movement was 0.3mm in x- and y-axis and below the slice thickness of 3.75mm in the z-axis in 11 patients. Conclusions: HFJV is feasible in 80% of patients allowing for near immobility of internal organs during liver, kidney, and lung tumor ablation.