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Bunnell History and High Frequency Jet Ventilator Theory

Bunnell History and High Frequency Jet Ventilator Theory

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High Frequency Jet
    Ventilation
From an Idea to a
    Device
"The substance of the lung is dilatable and extensible
  like the tinder made from a fungus. But it is spongy
      and if you press it, it yields to the force which
compresses it, and if the force is removed, it increases
           again to its original size."
          -- Leonardo da Vinci, late 15th century
"The gust of wind driven out of the lung in the
 generation of a large breath comes from the aid of
the abdominal wall which compresses the intestines,
 and they elevate the diaphragm which compresses
                     the lungs."
                                        - da Vinci
Adults were studied
  thoroughly . . .    but not babies.
The HFJV Story
Dr. Bunnell performs early aerosolized
surfactant studies at MIT in early 1970s.
Observes many babies dying or being
severely injured by early mechanical
ventilators.
Dr. Bunnell: “Is it possible to ventilate babies
              with smaller tidal volumes and
              lower pressures?”

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Bunnell History and High Frequency Jet Ventilator Theory

  • 1. High Frequency Jet Ventilation From an Idea to a Device
  • 2. "The substance of the lung is dilatable and extensible like the tinder made from a fungus. But it is spongy and if you press it, it yields to the force which compresses it, and if the force is removed, it increases again to its original size." -- Leonardo da Vinci, late 15th century
  • 3. "The gust of wind driven out of the lung in the generation of a large breath comes from the aid of the abdominal wall which compresses the intestines, and they elevate the diaphragm which compresses the lungs." - da Vinci
  • 4. Adults were studied thoroughly . . . but not babies.
  • 6. Dr. Bunnell performs early aerosolized surfactant studies at MIT in early 1970s. Observes many babies dying or being severely injured by early mechanical ventilators. Dr. Bunnell: “Is it possible to ventilate babies with smaller tidal volumes and lower pressures?”
  • 8. Convection/Diffusion Henderson, 1915
  • 9. Physiologic Basis for Using Small Tidal Volumes In 1915, Henderson was intrigued by the shallow breathing of panting dogs. He wondered how dogs could pant indefinitely without becoming hypoxic or hypercapnic. So, he designed an experiment to find out.
  • 10. 1915: Henderson Smoke Studies Convection penetrated smoke deeply through tube Effect was called “Flow Streaming”, the sort of flow we try to create with HFJV
  • 11. 1915: Henderson Smoke Studies Diffusion occurred when flow stopped or slowed
  • 13. Forced Oscillations DuBois and Assoc., 1956 Harvard School of Public Health
  • 14. V Resonant Frequency: Best Blood Gases Lowest Pressures 4 - 8 Hz
  • 15. Alveolar Air Equation VA = f (VT - VD) VT = 5 - 10 ml/kg VD anat. = 2 ml/kg
  • 16. Resonant Frequency fres = 4 to 8 Hz (adult) fres = ??? Hz (infants)
  • 17. fres = 4-8 Hz VT = 5 - 10 ml/kg fres = 10-15 Hz ?
  • 18. Dr. Bunnell: “How can you ventilate and oxygenate with tidal volumes smaller than deadspace volume?” “. . . you probably can’t.”
  • 19. Infrasound Johnson, 1973 Wright-Patterson AFB
  • 20. * * * * * * * * * * * * * ** * * ** * * * * * * * * * * * Jack Emerson: personal communication
  • 21. Jack Emerson: personal communication
  • 22. Pressure * * * * * * * ** ** * * ** * *** * ** * ** * * * * * * * ** * * Jack Emerson: personal communication
  • 23. Pressure * * * * * * * * * * * * * * * * * * ** * * * * * * * * * * * ** *** * Jack Emerson: personal communication
  • 26. Alveolar Air Equation VA = f (VT - VD) VD anat. = 2 ml/kg VT = ???
  • 27. Converting Decibels to Tidal Volume Db =~ P = k V => 1-2 ml/kg body weight
  • 28. Anatomic Dead Space Volume: The Great Equalizer in Mammals 3 Pygmy Chuck Norris Shrew * * * * ***** ** * * * * * ** **** ** * * * * 2 * * ** * **** * ** * * Blue * * * * PeeWee* * * * * * * VD * (ml/kg) Herman Whale 1 Small Medium Large Size
  • 29. Dr. Bunnell: “How can you possibly get good blood gases with such small tidal volumes?!” Colonel Johnson: “Why don’t YOU find out?” Dr. Bunnell: “Good idea.”
  • 30. If one pushes a big VT into a critter with a strapped chest, it doesn’t hurt its lungs . . . even when PIP is very high! VT
  • 31. If one pushes in that same VT without the strap, it causes the lungs to burst . . . even when PIP is not very high! VT
  • 32. High Frequency Jet Ventilation Bunnell, 1975 MIT
  • 33. Volume-Cost of Ventilation Tidal Volume vs. Frequency Tidal Volume (ml/kg) 3.5 3 2.5 2 1.5 1 0.5 0 0 200 400 600 800 Frequency (bpm)
  • 35. Eureka! “But how is this possible?”
  • 36. Mathematical Model of Gas Flow During HFJV Ellis, 1984 San Jose
  • 37. The Nature of Flow A stable flow is one nature can support Laminar: stable Turbulent: stable Transitional: unstable
  • 39. Dr. Bunnell: “How does HFJV create Transitional Flow?” - and - “How does HFJV avoid Turbulent Flow?”
  • 41. Bernoulli Effect creates Transitional Flow 0.02 Inspiratory Time avoids Turbulent Flow Text Gas accelerates into lungs Gas injected here
  • 42. Ellis: “You’ve found a way to support double- helical, bi-directional.” Dr. Bunnell: “Why does double-helical, bi-directional flow save babies?”
  • 44. Now For the Making and Marketing of HFV
  • 46. Bruce Dern Forest Ranger in outer space
  • 50. + =