SUPERIMPOSED HIGH-FREQUENCY JET VENTILATI ON (SHFJV) IN PATIENTS WITHMASSIVE STENOSIS OF THE LARYNX

Massive stenosis of the larynx may present a potentially life-threaten ing situation for the patient, requiring immediate measures to ensure a patient's airway. The aim of this prospective study was to evaluate potential benefits of Superimposed High Frequency Jet Ventilation (SHF JV) in patients requiring microlaryngeal surgery due to massive stenos is of the larynx. Patients and methods: 23 patients (age range 1,5 to 90 years) with laryngeal stenosis grade 2 and 3 according to the Cotto n scale were ventilated using SHFJV The duration of the SHFJV was 12 t o 116 minutes. SHFJV was performed using a Bronchotron Respirator via a jet-laryngoscope. Results: Arterial blood gases demonstrated paO2 be tween 71 and 295 mmHg and paCO2 of 28 to 81 mmHg. The mean FiO2 applie d was 61,75 +/- 19,26. The airway pressure was measured at the tip of the jet-laryngoscope and was between 6 and 15 mmHg, and PEEP was 1 to 5 mmHg. In 13 patients a CO2 laser was utilised during surgery. Discus sion: In all patients SHFJV was performed without problems. Since the ventilation is delivered above ans possible stenosis the danger of bar otrauma is minimised. The surgeon obtains optimal visibility of the la rynx and is not obstructed in the surgical procedure. SHFJV enables bo th the surgeon and the anesthesist to perform their respective duties and therefore increases the safety of the patient in the management of such a difficult problem as massive stenosis of the larynx.