Superimposed high-frequency jet ventilation (SHFJV) for endoscopic laryngotracheal surgery in more than 1500 patients

• Published in: British journal of anaesthesia : BJA Vol. 96; no. 5; pp. 650 - 659
• Main Authors: Rezaie-Majd, A., Bigenzahn, W., Denk, D.-M., Burian, M., Kornfehl, J., Grasl, M.Ch, Ihra, G., Aloy, A.
• Format: Journal Article
• Language: English
• Published: Oxford Elsevier Ltd 01-05-2006; Oxford University Press; Oxford Publishing Limited (England)
• Subjects: Adult; Aged; airway; Anesthesia; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Biological and medical sciences; Carbon Dioxide - blood; complications; complications, laryngeal/tracheal stenosis; Female; high-frequency jet; High-Frequency Jet Ventilation - methods; Humans; laryngeal/tracheal stenosis; Laryngoscopes; Laryngoscopy; Laryngostenosis - surgery; laser; Laser Therapy; Male; Medical sciences; Middle Aged; Oxygen - blood; Partial Pressure; Prospective Studies; surgery; surgery, laser; Tracheal Stenosis - surgery; ventilation; ventilation, high-frequency jet; surgery, laser; complications, laryngeal/tracheal stenosis; airway; ventilation, high-frequency jet; PaCO2; Ventilator; high-frequency jet; Catheter; Stenosis; Gas analysis; laser; ventilation; Hemorrhage; Stent; Anesthesia; Complication; Larynx; Laryngoscope; Child; Trachea; Human; Endoscopic surgery; Blood gas; Oxygen; Aspiration; Trauma; Arterial blood; laryngeal/tracheal stenosis; surgery; PaO2; Risk factor; Fire; Intubation; airway; complications; Oxygenation; High frequency ventilation; Barotrauma
• ISSN: 0007-0912; 1471-6771
• DOI: 10.1093/bja/ael074

Superimposed high-frequency jet ventilation (SHFJV), which does not require any tracheal tubes or catheters, was developed specifically for use in laryngotracheal surgery. SHFJV uses two jet streams with different frequencies simultaneously and is applied in the supraglottic space using a jet laryngoscope and jet ventilator.
Between 1990 and 2004, SHFJV was studied in 1515 consecutive patients (including 158 children requiring laryngotracheal surgery) prospectively. Ventilation was performed with an air/oxygen mixture and anaesthesia was administered i.v.
Adequate oxygenation and ventilation was achieved in 1512 patients. Arterial blood gas analyses (BGA) were performed between 1990 and 1994; thereafter BGA was only performed in patients with high-grade stenosis of the larynx/trachea or high-risk patients [n=623, mean PaO2 133.8 (39.4) mm Hg and mean PaCO2 42.3 (10.1) mm Hg]. There were no significant changes in PaO2 or PaCO2 during the entire period of SHFJV. No complications secondary to the ventilation technique were observed; in particular, no barotrauma occurred. Three patients required tracheal intubation. SHFJV was also successfully used for laser surgery (n=312). It proved to be a safe mode of ventilation without any complications such as airway fire, major haemorrhage, or aspiration of debris.
SHFJV is an advanced ventilation mode playing a pivotal role in the (open) ventilatory support/ventilation of patients with laryngotracheal stenosis. It is particularly indicated in cases of severe stenosis and offers optimal conditions for laryngotracheal surgery, including laser surgery and stent implantation techniques.