Airway Surgery Communication Protocol: A Quality Initiative for Safe Performance of Jet Ventilation

Matrka, Laura; Soldatova, Liuba; deSilva, Brad W.; Traetow, Daniel

doi:10.1002/lary.28271

Cited by 5 publications

(4 citation statements)

References 49 publications

(66 reference statements)

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“…A cohesive, experienced airway team comprised of a knowledgeable anesthesiologist, surgical technician, nursing staff, and otolaryngologist are important to the safety and efficiency of care in management of LTS, however, clear communication and collaboration between all members of the team and clear establishment of the role of each team member prior to beginning the procedure is of utmost importance. In a study by Matrka et al, a standardized communication protocol was consistently followed, and the complication rate remained low despite the experience of the airway team 15 . Our results demonstrate a cohesive airway team mitigates many of the risks of advanced ventilatory techniques like jet ventilation in surgery for LTS.…”

Section: Discussionmentioning

confidence: 54%

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Multi‐Institutional Analysis of Outcomes in Supraglottic Jet Ventilation with a Team‐Based Approach

et al. 2021

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Objectives/Hypothesis: To evaluate the safety and complications of endoscopic airway surgery using supraglottic jet ventilation with a team-based approach.Study Design: Retrospective cohort study.Methods: Subjects at two academic institutions diagnosed with laryngotracheal stenosis who underwent endoscopic airway surgery with jet ventilation between January 2008 and December 2018 were identified. Patient characteristics (age, gender, race, follow-up duration) and comorbidities were extracted from the electronic health record. Records were reviewed for treatment approach, intraoperative data, and complications (intraoperative, acute postoperative, and delayed postoperative).Results: Eight hundred and ninety-four patient encounters from 371 patients were identified. Intraoperative complications (unplanned tracheotomy, profound or severe hypoxic events, barotrauma, laryngospasm) occurred in fewer than 1% of patient encounters. Acute postoperative complications (postoperative recovery unit [PACU] rapid response, PACU intubation, return to the emergency department [ED] within 24 hours of surgery) were rare, occurring in fewer than 3% of patient encounters. Delayed postoperative complications (return to the ED or admission for respiratory complaints within 30 days of surgery) occurred in fewer than 1% of patient encounters. Diabetes mellitus, active smoking, and history of previous tracheotomy were independently associated with intraoperative, acute, and delayed complications.Conclusions: Employing a team-based approach, jet ventilation during endoscopic airway surgery demonstrates a low rate of complications and provides for safe and successful surgery.

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Section: Discussionmentioning

confidence: 54%

“…In a study by Matrka et al, a standardized communication protocol was consistently followed, and the complication rate remained low despite the experience of the airway team. 15 Our results demonstrate a cohesive airway team mitigates many of the risks of advanced ventilatory techniques like jet ventilation in surgery for LTS.…”

Section: Discussionmentioning

confidence: 69%

Multi‐Institutional Analysis of Outcomes in Supraglottic Jet Ventilation with a Team‐Based Approach

et al. 2021

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“…Although jet ventilation can be associated with severe complications, proper training, technical familiarity, low MJV parameters, and good communication between the members of the team will provide a safe jet ventilation capable facility. 27…”

Section: Discussionmentioning

confidence: 99%

Low Pressure Low Frequency Jet Ventilation: Techniques, Safety and Complications

Myint¹,

Teng

Butler

et al. 2022

Ann Otol Rhinol Laryngol

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Objective: Manual jet ventilation is a specialized oxygenation and ventilation technique that is not available in all facilities due to lack of technical familiarity and fear of complications. The objective is to review our center’s 15 year experience with low pressure low frequency jet ventilation (LPLFJV). Methods: Retrospective review of procedures utilizing LPLFJV from 2005 to 2019 were performed collecting patient demographic, surgery type and complications. Fisher exact test, Chi square, and t-test were used to determine statistical significance. Results: Four hundred fifty-seven patients underwent a total of 891 microlaryngeal surgeries—279 cases for voice disorders, 179 for lesions, and 433 for airway stenosis. The peak jet pressure for all cases did not exceed 20 psi and average peak pressure for the last 100 procedures in this case series was 14.9 ± 4.6 psi. The average lowest oxygen saturation for all cases was 95% ± 0.6%. Brief intubation was required in 154 cases (17%). Surgical duration was significantly longer for cases requiring intubation P < .001. The need for intubation was not associated with smoking or cardiopulmonary disease, but was strongly associated with body mass index (BMI). Intubation rates were 7% for normal weight (BMI < 25, N = 216), 13% for overweight (BMI 25-30, N = 282), 24% for obese (BMI 30-40, N = 342), and 37% for morbidly obese (BMI > 40, N = 52) patients. Three patients developed respiratory distress in the recovery unit and 2 patients required intubation. Conclusion: LPLFJV assisted by intermittent endotracheal intubation is an exceedingly safe and effective intraoperative oxygenation and ventilationmodality for a broad variety of laryngeal procedure.

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“…Incisions were created along the right and left aryepiglottic folds using a 4 W superpulsed CO 2 laser in continuous mode (Figure 1B). 10 The anterior-facing arytenoid mucosa and the lateral portion of the laryngeal epiglottic mucosa were then further denuded using the CO 2 laser on defocused settings. The median glossoepiglottic fold was then incised with a CO 2 laser to allow for additional epiglottic release (Figure 1C).…”

Section: Case Reportmentioning

confidence: 99%

A Novel Approach for the Treatment of Intractable Aspiration After Supracricoid Laryngectomy

Alsavaf

Tardif

Salem

et al. 2023

Ann Otol Rhinol Laryngol

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Objectives: This manuscript aims to present a novel and successful intervention for intractable aspiration following a supracricoid laryngectomy (SCL) that may avoid the need for total laryngectomy in patients experiencing intractable aspiration after SCL. Study design: This report describes a novel approach to treat intractable aspiration and feeding tube-dependency due to an incomplete posterior apposition of the laryngeal surface of the epiglottis to the arytenoids after a SCL in a 67-year-old man. Methods: The right and left aryepiglottic folds and the median glossoepiglottic fold were denuded using a CO2 laser. Then, an arytenoepiglottopexy was completed by placing 4-0 Vicryl between the lateral aspect of the epiglottis and arytenoids; thus, approximating these structures. Results: Two weeks after surgery, fiberoptic endoscopic evaluation of swallowing demonstrated improved closure of the larynx upon swallowing with great upgrading in the Penetration-Aspiration scale (PAS). PAS improved from a 6 to 2, corresponding to, transient penetration for moderately thick liquids and puree solids. He also demonstrated improved secretion management and airway protection. Following a 4-week course of intensive dysphagia therapy, a modified barium swallow revealed a significant improvement in airway protection, with a PAS score of 1 (no airway invasion). Conclusions: Chronic aspiration is a life-threatening condition that can severely reduce patients’ quality of life. Despite the use of current therapeutic approaches, a subset of patients will remain plagued by persistent symptoms. We introduce an innovative, simple, and quick endoscopic technique that offers benefit in controlling aspiration after SCL. Level of Evidence: NA

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Airway Surgery Communication Protocol: A Quality Initiative for Safe Performance of Jet Ventilation

Cited by 5 publications

References 49 publications

Multi‐Institutional Analysis of Outcomes in Supraglottic Jet Ventilation with a Team‐Based Approach

Multi‐Institutional Analysis of Outcomes in Supraglottic Jet Ventilation with a Team‐Based Approach

Low Pressure Low Frequency Jet Ventilation: Techniques, Safety and Complications

A Novel Approach for the Treatment of Intractable Aspiration After Supracricoid Laryngectomy

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