The efficacy of high-frequency jet ventilation on intraoperative oxygen saturation compared to cross-field ventilation in patients undergoing carinal resection and reconstruction

Abstract

Background: Cross-field ventilation is used as a conventional choice during carinal resection and anastomosis, but may interfere with surgical procedures. High-frequency jet ventilation (HFJV) allows for control of oxygenation in the open airways; nevertheless, there is a paucity of data to support its benefits versus cross-field ventilation. Herein, we aimed to investigate the efficacy of HFJV on intraoperative oxygen saturation compared with cross-field ventilation in patients undergoing carinal surgeries.Methods: We conducted a retrospective analysis of 82 adults who underwent carinal resection and reconstruction (CRR) for benign or malignant diseases and received cross-field ventilation or HFJV at Shanghai Chest Hospital between January 2018 and September 2021. Patients were excluded when they had emergency surgeries or critical airway stenosis requiring extracorporeal life support, or limited resection without the need for cross-field ventilation or HFJV. Patients were classified into two groups based on the airway approach: cross-field ventilation group and HFJV group. The primary outcome was the area under the curve (AUC) of intraoperative hypoxemia defined as peripheral oxygen saturation (SpO 2 ) below 90% lasting at least 1 minute. The secondary outcomes included cumulative time of SpO 2 below 90%, AUC and cumulative time of severe intraoperative hypoxemia (defined as SpO 2 below 80% lasting at least 1 minute), and AUC and cumulative time of suboptimal SpO 2 (defined as SpO 2 below 95% lasting at least 1 minute).Results: Thirty-two patients were included in the final analysis, with 22 patients in cross-field ventilation group and 10 patients in HFJV group. The two groups did not differ in the severity and duration of intraoperative hypoxemia (P=0.366). The median (IQR) AUC of SpO 2 below 90% was 21.92 (4.28, 54.48) min in cross-field ventilation group and 28. 93 (10.78, 199.89) min in HFJV group. The cumulative time of SpO 2 <90% was 16.67 (4.46, 37.11) min in cross-field ventilation group and 19.32 (7.50, 121.24) min in HFJV group, without statistical difference between groups (P>0.05). Severe intraoperative hypoxemia did not occur in either group.Conclusions: This retrospective case series demonstrates that HFJV can be adopted to maintain oxygenation in CRR, without the interruption of surgical procedure.

Resektionen der Trachealbifurkation

“…Als Alternative zur OP-Feld-Beatmung hat sich in der Chirurgie der zentralen Atemwege die Hochfrequenz-Jet-Ventilation (HFJV) etabliert [18,19,20]. Auch eine Kombination beider Verfahren ist üblich [21].…”

Uniportal fully robotic-assisted sleeve resections: surgical technique and initial experience of 30 cases

“…For this reason, when this procedure is performed through uRATS, we recommend two options in order to maintain lung ventilation: the use of high frequency jet ventilation or with the help of extracorporeal membrane oxygenation (ECMO). The jet tube can be introduced through the endotracheal tube and thanks to the small diameter of the catheter for ventilation, it doesn’t interfere with the anastomosis of the membranous portion ( 21 ). This way we do not need intra-field intubation ( Figure 7D ).…”

VATS sleeve resections

“…Thus, the procedure can be completed without the need to remove the tube from the field during anastomosis and without exposing the patient to hypoxemia. [ 25 ]…”