High-Frequency Jet Ventilation in Tracheal Surgery


Anestezi Dergisi, vol.31, pp.228-229, 2023 (Scopus) identifier

  • Publication Type: Article / Article
  • Volume: 31
  • Publication Date: 2023
  • Journal Name: Anestezi Dergisi
  • Journal Indexes: Scopus, Academic Search Premier, Central & Eastern European Academic Source (CEEAS), EMBASE, TR DİZİN (ULAKBİM)
  • Page Numbers: pp.228-229
  • Keywords: Adequate oxygenation, jet ventilation, tracheal surgery
  • Hacettepe University Affiliated: Yes


Background: Methods of airway management depend on the location and growth pattern of the obstructive mass, as well as the degree of airway obstruction and surgical approach. The advantages of high-frequency jet ventilation (HFJV) include preserved gas exchange, decreased ventilation/perfusion mismatch and risk of atelectasis due to reduced auto-positive end-expiratory pressure, and minimal hemodynamic changes (1-2). Our aim is to share our ventilation strategy during an emergency surgery for repairing tracheal laceration. Case: A 54-years-old female patient who was diagnosed with esophageal squamous cell carcinoma. She had total esophagectomy, total gastrectomy, and transverse colon interposition surgery. She developed shortness of breath and low saturation levels on the sixth postoperative day. After CT scan revealed a defect located right posterolateral part of trachea 8 mm superior to carina the patient was admitted for emergency surgery for repair. She was intubated with a double lumen tube for one-lung ventilation. But the patient's airway pressures increased and saturation decreased to 60% and she was re-intubated with a single lumen tube. At this time, it was observed that the laceration reached 2-3 cm diameter. Despite our ventilation efforts, the saturation decreased to 25%, and vasopressor infusion was started. We decided to use cardiopulmonary bypass (CPB) to proceed with the surgery. When the patient's blood gas analysis show PaC02 was 109 mmHg and Pa02 pressure was 23 mmHg we decided to apply high-frequency jet ventilation until cardiopulmonary bypass therapy was established. HFJV was applied by inserting the catheter to the left main bronchus through the endotracheal tube while simultaneously ventilating. With jet ventilation, the patient's Pa02 value increased to 60.4 mmHg and PaC02 values began to decrease gradually. After switching to CPB the primary tracheal repair was completed, the patient was transported to the intensive care unit. Conclusion: HFJV has been used as an auxiliary ventilation technique to conventional ventilation in endolaryngeal surgeries and can be considered as a good option. However, the team should keep in mind that the procedure itself may have complications. If adequate oxygenation cannot be achieved, jet ventilation should be considered in tracheal surgery.