Abstract
Difficult airway is still a challenging field in anesthesia, emergency departments and intensive care unit and is the cause of severe patient injury such as irreversible hypoxic brain damage or even death. Therefore, safer techniques are needed to maintain the airway in patients, who are difficult to intubate. The aim was to analyze the safety of the technique of transcricoid high frequency jetventilation (TCHFJV) by the investigation of complications. We performed a 10-year retrospective analysis (1/2009-1/2019) of patients subjected to TCHFJV at the hospital of the Ludwigs-Maximilians-University, Munich, Germany. TCHFJV was applied before anesthesia induction in awake, spontaneously breathing patients, with suspected or known difficult airway, scheduled for head and neck surgery. During the 10-year study period, we identified 39,477 patients, who underwent neck surgery. Of these, 1489 (3.8%) patients were managed with TCHFJV (1090 males, 399 females; 62 ± 13 years, BMI 25 ± 0.2 kg?m-2, ASA class 3 ± 0.5). TCHFJV was successful in 1479 (99%) patients. Subsequent endotracheal intubation was performed in most cases (93%). Occasionally, emergency cricothyroidotomy (n = 2) or tracheotomy (n = 6) was necessary following TCHFJV. TCHFJV-related complications occurred in 1.5% of the cases. A majority (83%) of the complications were judged to be non-severe (grade 1, 2A) and 17% were severe (grade 3B), while there were none that were very severeC or lethalD. This retrospective study indicates that TCHFJV in experienced hands is a relatively safe alternative airway management strategy for patients undergoing neck surgery.
Highlights
The aim was to analyze the safety of the technique of transcricoid high frequency jetventilation (TCHFJV) by the investigation of complications
During the 10-year study period, we identified 39,477 patients, who underwent neck surgery
It is difficult to perform a TCHFJV in an emergency situation, if it was not practiced before routinely
Summary
The management of the difficult airway is challenging, because the problem has to be solved within 3 minutes to prevent hypoxic brain damage or death. Adverse outcomes of airway problems are by no means rare: A recent study conducted in the UK and comprising 184 recorded events in intensive care units or emergency departments documented that 61% of these events resulted in death or persistent neurological damage [1]. 16 deaths and three episodes of persistent brain damage were due to complications of airway management in this study. An underestimated option for the management of the anticipated difficult airway is transcricoid high frequency jetventilation (TCHFJV), which was derived from the earliest described ventilation type: air insufflation. Jacoby et al described the first transtracheal high frequency ventilation, which was interrupted air insufflation, in 5 patients with oropharyngeal/laryngeal tumors [4]. The improvement of airway management is still an important topic in anesthesia, intensive care and emergency medicine
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