High-frequency jet ventilation in endolaryngeal surgery

Abstract

Study Objective: To describe the clinical experience with high-frequency jet ventilation (HFJV) of the lungs during endolaryngeal surgery and its effect on acid-base balance and capillary PO 2 (PcO 2), PCO 2, central hemodynamics, and tracheobronchial mucous membrane. Design: Evaluation of different modalities of HFJV. Setting: Operating rooms and otolaryngology intensive care unit in a medical institute. Patients: 218 patients undergoing elective endolaryngeal surgery. Interventions: Patients receive HFJV through catheters with an inner diameter of 1.4 to 1.8 mm. Catheters were introduced orotracheally, nasotracheally, percutaneously, or through a fenestrated tracheostomy tube. Minute volume was based on body weight times 0.2, correctected for acid-base balance. Measurements and Main Results: Intraoperative cardiac output, airway pressure, changes in tracheobronchial mucosa, and acid-base balance were monitored. HFJV changed central hemodynamics slightly and preserved gas exchange: PcCO 2 remained within normal limits, while PcO 2 increased. Use of thin catheters enhanced largyneal exposure and surgical manipulation. Percutaneous catheterization permitted resumption of HFJV in the event of laryngeal edema and inadequate spontaneous respiration after surgery. Conclusion: HFJV leads to optimal conditions for endolaryngeal surgery, reverses constant outflow of the respiratory gas mixture, prevents aspiration of tissue products and blood, and removes smoke from the operative site when using laser surgery.