Perioperative recommendations in a child with Fish Odor Syndrome

Abstract

Currently available in vivo data on transtracheal jet ventilation in a can't intubate, can't ventilate (CICV) situation are very limited. However, there are several case reports in the literature on barotrauma and circulatory collapse caused by hyperinflation when using jet ventilation. In the article of Jaquet et al. it is clearly stated that even in elective surgery all major complications were because of the pursuit of jet ventilation despite an obstructed airway.The central issue in our article, however, is not the incidence of complete upper airway obstruction, as this problem can never be excluded in a CICV situation, but how to minimize the risks of jet ventilation for our patients. Self-assembled devices are often not thoroughly tested and may carry inherent risks. Our data reveal a potential hazard of the three-way stopcock based emergency jet ventilation devices that are widely recommended and taught also by Dr. Heard (2). We point to an inherent risk of insufficient flow and pressure release, which can lead to high intrathoracic pressure, barotrauma, and circulatory collapse. We do not question jet ventilation as such, but the dangerous self-assembled equipment still advised by some.