Transtracheal high frequency jet ventilation in adults and chldren

Abstract

Percutaneous high frequency transtracheal jet ventilation (TTJV) is a useful technique for diagnostic and therapeutic endoscopy of the larynx and subglottic space in otolaryngological patients. It provides excellent operative conditions by increasing the exposure of the surgical field, provides adequate gas exchange and reduces ignition hazards, all conditions that greatly increase the safety of the procedure. Postoperative endotracheal intubation or even tracheotomy may thus be avoided. The insertion of the catheter is a safe procedure provided that it is performed under direct endoscopic control. Adequate monitoring of the end-expiratory pressure together with constant clinical surveillance of chest movements and gas egress are of great importance to avoid pulmonary barotrauma. Because TTJV is more invasive than orotracheal intubation, it should not be used as a routine technique in pediatric endoscopic surgery, despite its advantages. However, in selected cases such as those with upper airway stenosis, TTJV can avoid a difficult and complicated procedure or the need for a tracheotomy and should therefore be considered and performed by experienced practitioners in specialized centers.