High frequency jet ventilation at the distal end of tracheostenosis during flexible bronchoscopic resection of large intratracheal tumor: Case series

Application of a new tracheal inducer to therapeutic flexible bronchoscopy for airway management: a case report

The ventilation methods during therapeutic flexible bronchoscopy vary among anesthesiologists and institutions, but each method has its own pitfalls. Therefore, improvement of the airway equipment is important. Here, we present a case in which a new tracheal inducer (Safe Easy Endotracheal Kit-flexible, SEEK^flex) was applied in bronchoscopic balloon dilation under general anesthesia for airway management. This technology utilizes a flexible bronchoscope to reveal the glottis for tracheal placement of the SEEK^flex to allow subglottic jet ventilation, illustrating the prominent function of performing SEEK^flex-guided tracheal intubation in case of rapid sequence intubation. The SEEK^flex can be easily inserted into the trachea transnasally without the aid of other devices, without significant kink and displacement during the jet ventilation. The SEEK^flex could provide good airway control by facilitating sufficient ventilation, optimizing surgical access and guiding tracheal intubation when necessary.

Clinical study of multifunctional laryngeal mask in airway interventional therapy

OBJECTIVE

This study is conducted to evaluate the efficacy and safety of using multifunctional intubation laryngeal masks with normal frequency jet ventilation in airway interventional therapy.

METHODS

A total of 200 patients receiving airway interventional therapy were enrolled in this retrospective study and were divided into 2 groups (group M and group P) by doctors in our hospital to compare the effect of different laryngeal masks. Group M used common laryngeal masks and an anesthesia machine for positive pressure ventilation while group P took multifunctional intubation laryngeal masks and used a jet ventilator for normal frequency jet ventilation. The patients' mean arterial pressure, heart rate, arterial oxygen partial pressure (PaO2) and arterial carbon dioxide partial pressure (PaCO2), and the operation time, recovery score and the patients' and doctors' satisfaction levels were compared between the 2 groups.

RESULTS

Both groups were hemodynamically stable, and their PaO2 levels were significantly higher before the operation than that during and after the operation (P < .05). Compared with group M, the PaCO2 level of group P was more stable both during and after the operation, and this difference was statistically significant (P < .05). There was no statistically significant difference in terms of the 2 group's operating time, recovery score, and patients' satisfaction levels (P > .05). However, the satisfaction levels of doctors in group P were higher than that in group M, and this difference was statistically significant (P < .05).

CONCLUSION

As statistics show, the intraoperative hemodynamics and PaO2 and PaCO2 levels were stable, and patients, surgeons and anesthesia operators were satisfied. Therefore, it is feasible to apply multifunctional intubation laryngeal masks with normal frequency jet ventilation in airway interventional therapy and it is a safe and ideal way to ensure ventilation.

The efficacy of high-frequency jet ventilation on intraoperative oxygen saturation compared to cross-field ventilation in patients undergoing carinal resection and reconstruction

Background

Cross-field ventilation is used as a conventional choice during carinal resection and anastomosis, but may interfere with surgical procedures. High-frequency jet ventilation (HFJV) allows for control of oxygenation in the open airways; nevertheless, there is a paucity of data to support its benefits versus cross-field ventilation. Herein, we aimed to investigate the efficacy of HFJV on intraoperative oxygen saturation compared with cross-field ventilation in patients undergoing carinal surgeries.

Methods

We conducted a retrospective analysis of 82 adults who underwent carinal resection and reconstruction (CRR) for benign or malignant diseases and received cross-field ventilation or HFJV at Shanghai Chest Hospital between January 2018 and September 2021. Patients were excluded when they had emergency surgeries or critical airway stenosis requiring extracorporeal life support, or limited resection without the need for cross-field ventilation or HFJV. Patients were classified into two groups based on the airway approach: cross-field ventilation group and HFJV group. The primary outcome was the area under the curve (AUC) of intraoperative hypoxemia defined as peripheral oxygen saturation (SpO₂) below 90% lasting at least 1 minute. The secondary outcomes included cumulative time of SpO₂ below 90%, AUC and cumulative time of severe intraoperative hypoxemia (defined as SpO₂ below 80% lasting at least 1 minute), and AUC and cumulative time of suboptimal SpO₂ (defined as SpO₂ below 95% lasting at least 1 minute).

Results

Thirty-two patients were included in the final analysis, with 22 patients in cross-field ventilation group and 10 patients in HFJV group. The two groups did not differ in the severity and duration of intraoperative hypoxemia (P=0.366). The median (IQR) AUC of SpO₂ below 90% was 21.92 (4.28, 54.48) min in cross-field ventilation group and 28.93 (10.78, 199.89) min in HFJV group. The cumulative time of SpO₂ <90% was 16.67 (4.46, 37.11) min in cross-field ventilation group and 19.32 (7.50, 121.24) min in HFJV group, without statistical difference between groups (P>0.05). Severe intraoperative hypoxemia did not occur in either group.

Conclusions

This retrospective case series demonstrates that HFJV can be adopted to maintain oxygenation in CRR, without the interruption of surgical procedure.