TWINSTREAM Superimposed High – Frequency Jet -Ventilation (SHFJV®)
TwinStream™ Multi Mode Respirator for tubeless jet laryngoscopy, jet bronchoscopy, jet tracheoscopy and all types of jet ventilation in the fields of surgery and intensive medicine.
Superimposed High – Frequency Jet –Ventilation (SHFJV®)
TwinStream™ is the first microprocessor-driven Superimposed High-frequency Jet ventilation apparatus and sets an entirely new standard in the jet ventilation technique.
The first TwinStream™ jet ventilation systems for superimposed high-frequency jet ventilation were delivered at the beginning of 2006. In the meantime, users in Europe, Middle East, Russia an now China trust TwinStream™ as well as its patented jet endoscopes and accessories as a system-based solution for jet ventilation.
All displays for monitoring are explicit and clearly structured. The alarm limits can be defined by the operator and can be set rapidly. TwinStream™ is the only ventilation apparatus in the world which, on the one hand, offers the option of being used in combination with patented jet endoscopes and, on the other hand, permits measurement of inspiratory oxygen concentration (FiO2Aw) in the respiratory tract by the use of 3- and 4-lumen catheters. The inspiratory oxygen concentration limit (FiO2Aw) which is set within the respirator by the electronic mode, and in the “laser-safe mode” for laser surgery, is an essential safety factor of TwinStream™. This function makes it the first ventilation apparatus in the world that prevents an excessively high inspiratory oxygen concentration (FiO2Aw) and thus reduces the risk of burn. The use of laser is permitted only when the oxygen concentration in the respiratory tract is below 35%. Besides, an end-tidal CO2 measurement module (etCO2) is optionally available.
Twinstream™ consists of two separately or simultaneously operating ventilation units. In superimposed jet ventilation (SHFJV®), jet ventilation of normal frequency and high frequency is conducted simultaneously. In addition, Twinstream™ permits ventilation at two different pressure plateaus. The level of the pressure plateau as well as the duration of inspiration and expiration can be selected. Thus, oxygenation as well as CO2 elimination can be regulated efficiently.
Measurements on the lung model have clearly shown that an adequate respiratory displacement volume, especially in cases of limited lung compliance, can only be achieved by a combination of low- and high-frequency jet ventilation.
With high-frequency jet ventilators equipped with only one frequency….
it is practically impossible to achieve adequate gas exchange in the open system. One has to choose between a respiration pattern of normal frequency with sufficient CO2 elimination at the expense of oxygenation, or a high-frequency respiration pattern with sufficient oxygenation but a rapid rise in pCO2.
While ordinary jet ventilators usually provide too low emission pressures and are frequently provided with only one ventilation frequency, TwinStream™ is equipped with two separate or simultaneously operating ventilation components. In superimposed high-frequency jet ventilation®, high-frequency jet ventilation and ventilation of normal frequency are conducted simultaneously. In addition, TwinStream™ permits ventilation at two different pressure levels. The level of the pressure plateau as well as the duration of inspiration and expiration can be selected by the operator. Thus, oxygenation and CO2 elimination can be regulated. Due to its enormous spectrum of applications it can be used in neonates and even in highly obese adults. By the use of special surgical laryngoscopes, tracheoscopes, bronchoscopes and jet adapters, the operator has the unique option of administering “tubeless” ventilation. No ventilation tube or jet catheter hinders the surgeon, and the field of surgery is not restricted. Optionally, high-flow breath gas conditioning is available for TwinStream™.
TwinStream™ is predestined for use especially in laryngeal micro- and laser surgery, for tracheal stent application and resection of the trachea. A comprehensive range of synchronised TwinStream™ accessories are available for this purpose.
The films clearly show that, when SHFJV® is used, no ventilation tube or jet catheter impairs the surgeon’s work or limits the field of surgery. In cases of tubeless ventilation, the risk of burn is ruled out because no inflammable materials are present in the respiratory tract. A tracheotomy is no longer required for respiratory reasons. Jet laryngoscopes – optimised in terms of flow technology – provide sufficient ventilation with no time limit.
Breath gas flow through the jet laryngoscope
For comparison conventional ventilation with Endotracheal-Tube
The photographs clearly show massive impairment of the field of surgery by endotracheal tubes or jet catheters. The surgeon is faced with the persistent risk of burn when using laser. In case of sudden swelling of tissue, the patient is exposed to the acute risk of barotrauma. For many indications, a tracheotomy is required for respiratory reasons.
Larynx with tube for conventionel anesthisia devices
Stenosis with Jet-Catheter for infraglottic Jet-ventilation
Infraglottic and supraglottic ventilation according to Dr. Aloy with SHFJV® without an endotracheal tube or a jet catheter.
Stenosis – no impairment of view by a tube or a catheter!
Stenosis, viewed without obstruction through the Jet Endoscope
The larynx is seen in its natural state because of the absence of a tube or jet catheter
Jet endoscopes and accessories
The connected jet instruments or accessories play a major role in guaranteeing jet ventilation with no time limit.
With the TwinStream™ jet ventilation system, the individual jet endoscopes and accessories are all measured in terms of flow technology. Every connection or nozzle is placed in an optimal position with regard to flow and is measured along with the jet ventilation system TwinStream™ before it is delivered to the user. This guarantees highest safety as well as reliable and adequate ventilation in the open system. At our manufacturing unit we produce connecting tubes and nozzles for gas analysis and ventilation, and adapt these to industrially manufactured instruments. After functional tests and certification, the instruments are rendered available for your use.
The following accessories are available for you:
Carl Reiner Jet-Laryngoscopes
Carl Reiner Jet-Bronchoscopes
Carl Reiner Jet-Tracheoscopes
Carl Reiner Jet adapters for existing endoscopes
Carl Reiner Jet-Katheter
Carl Reiner Jet-Konverter
Jet ventilation and its application options
The following film excerpts will give you a brief overview of the options of jet ventilation in clinical use.
SHFJV® in microlaryngoscopic procedures
SHFJV® in using with a modular laryngoscope system
SHFJV® in rigid and interventional bronchoscopic procedures
Veres method SHFJV® with Larynxmask and Jet Converter during flexible bronchoscopies
SHFJV® in thoracic surgery procedures
SHFJV® in percutaneus dilatation tracheotomy acc to Prof Klemm, MD