Superimposed high-frequency jet ventilation for laryngeal and tracheal surgery

Objective: To describe our experience with superimposed high-frequency jet ventilation (SHFJV), which does not require any endotracheal tubes or cathe ters, for performing laryngeal and tracheal surgery. Design: A case series of 500 patients. Setting: A university medical center. Patients: Four hundred sixty adult patients and 40 children in a consecutiv e sample who required laryngeal or tracheal surgery under SHFJV. Interventions: The SHFJV uses 2 jet streams with different frequencies simu ltaneously and is applied using a jet laryngoscope. Ventilation was perform ed with an air-oxygen mixture, and intravenous agents were used for anesthe sia. Arterial blood gas values were analyzed. Main Outcome Measures: Reported Values of oxygenation and ventilation durin g the application of SHFJV and laryngotracheal surgery. Results: In 497 patients, adequate oxygenation with a mean +/- SD PaO2 of 9 1.8 +/- 22.9 mm Hg and ventilation with a PaCO2 of 29.7 +/- 5.5 mm Hg were achieved using SHFJV. The average duration of the application of ventilatio n was 27 minutes, and the longest duration was 118 minutes. No complication s due to the ventilation technique were observed. Laser surgery was perform ed in 150 patients. Conclusions: The use of SHFJV in combination with the jet laryngoscope prov ides patients with sufficient ventilation during laryngotracheal surgery. E ven in patients at high risk because of pulmonary or cardiac disease, this technique call be applied safely. In patients with stenosis, the ventilatio n is applied from above the stenosis, reducing the risk of barotrauma. The SHFJV can be used for tracheobronchial stent insertion, and laser can be us ed without any additional protective measures.