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Test the hypothesis that the center of ventilation, a measure of ventro-dorsal atelectasis, is posterior during supraglottic ventilation indicating better dependent-lung ventilation. Secondarily, we tested the hypothesis that supraglottic ventilation improves oxygenation and carbon dioxide elimination. Supraglottic and subglottic jet ventilation are both used during laryngotracheal surgery. Supraglottic jet ventilation may better prevent atelectasis and provide superior ventilation. Randomized, cross-over trial. Operating rooms. Patients having elective micro-laryngotracheal surgery. Patients were sequentially ventilated for 5 min with one randomly selected type of jet ventilation before being switched to the alternative method. Regional ventilation distribution was estimated using electrical impedance tomography, with arterial oxygenation and carbon dioxide partial pressures being simultaneously evaluated. Thirty patients completed the study. There were no statistically significant or clinically meaningful differences in the center of ventilation with supraglottic and subglottic ventilation. However, ventilation with the supraglottic approach was about 4 % higher in the ventromedial lung region and about 4 % lower in the dorsal lung. Surprisingly, arterial blood oxygenation was considerably worse with supraglottic (173 [156, 199] mmHg) than subglottic ventilation (293 [244, 340] mmHg). Arterial carbon dioxide partial pressure was near 40 mmHg with each approach, although slightly lower with supraglottic jet ventilation. The center of ventilation distribution, a measure of atelectasis, was similar with supraglottic and subglottic jet ventilation. Subglottic jet ventilation improved the dorsal-dependent lung region and provided superior arterial oxygenation. Both techniques effectively eliminated carbon dioxide, with the supraglottic approach demonstrating slightly superior efficacy. •In a cross-over trial, we compared supraglottic and subglottic jet ventilation during open-airway laryngeal surgery.•Jet ventilation did not significantly shift the overall center of ventilation as determined by EIT.•Supraglottic jet ventilation worsened ventilation in dorsal lung regions compared to subglottic jet ventilation by 4 %.•Oxygenation was substantially better with subglottic than supraglottic jet ventilation.•Either type of jet ventilation appears suitable for open-airway laryngeal surgery.

Background High frequency jet ventilation (HFJV) is an open ventilating technique to maintain ventilation for emergency or difficult airway. However, whether jet ventilation or conventional oxygen therapy (COT) is more effective and safe in maintaining adequate oxygenation, is unclear among patients with airway stenosis during bronchoscopic intervention (BI) under deep sedation. Methods A prospective randomized cohort study was conducted to compare COT (high flow oxygen) with normal frequency jet ventilation (NFJV) and HFJV in oxygen supplementation during BI under deep sedation from March 2020 to August 2020. Patients receiving BI under deep sedation were randomly divided into 3 parallel groups of 50 patients each: the COT group (fractional inspired oxygen (FiO 2 ) of 1.0, 12 L/min), the NFJV group (FiO 2 of 1.0, driving pressure of 0.1 MPa, and respiratory rate (RR) 15 bpm) and the HFJV Group (FiO 2 of 1.0, driving pressure of 0.1 MPa, and RR of 1200 bpm). Pulse oxygen saturation (SpO 2 ), mean arterial blood pressure and heart rate were recorded during the whole procedure. Arterial blood gas was examined and recorded 15 min after the procedure was initiated. The procedure duration, dose of anesthetics, and adverse events during BI in the three groups were also recorded. Results A total of 161 patients were enrolled, with 11 patients excluded. The clinical characteristics were similar among the three groups. PaO 2 of the COT and NFJV groups was significantly lower than that of the HFJV group ( P  < 0.001). PaO 2 was significantly correlated with ventilation mode (P < 0.001), body mass index (BMI) ( P  = 0.019) and procedure duration ( P  = 0.001). Multiple linear regression showed that only BMI and procedure duration were independent influencing factors of arterial blood gas PaO 2 ( P  = 0.040 and P  = 0.002, respectively). The location of airway lesions and the severity of airway stenosis were not statistically correlated with PaCO 2 and PaO 2 . Conclusions HFJV could effectively and safely improve intra-operative PaO 2 among patients with airway stenosis during BI in deep sedation, and it did not increase the intra-operative PaCO 2 and the risk of hypercapnia. PaO 2 was correlated with ventilation mode, BMI and procedure duration. Only BMI and procedure duration were independent influencing factors of arterial blood gas PaO 2 . PaCO 2 was not correlated with any preoperative factor. Trial registration Chinese Clinical Trial Registry. Registration number, ChiCTR2000031110 , registered on March 22, 2020.

Abstract Due to growing interest in management of central airway obstruction, rigid bronchoscopy is undergoing a resurgence in popularity among pulmonologists. Performing rigid bronchoscopy requires use of deep sedation or general anesthesia to achieve adequate patient comfort, whereas maintaining oxygenation and ventilation via an uncuffed and often open rigid bronchoscope requires use of ventilation strategies that may be unfamiliar to most pulmonologists. Available approaches include apneic oxygenation, spontaneous assisted ventilation, controlled ventilation, manual jet, and high-frequency jet ventilation. Anesthetic technique is partially dictated by the selected ventilation strategy but most often relies on a total intravenous anesthetic approach using ultra–short-acting sedatives and hypnotics for a rapid offset of action in this patient population with underlying respiratory compromise. Gas anesthetic may be used with the rigid bronchoscope, minimizing leaks with fenestrated caps placed over the ports, although persistent circuit leaks can make this approach challenging. Jet ventilation, the most commonly used ventilatory approach, may be delivered manually using a Sanders valve or via an automated ventilator at supraphysiologic respiratory rates, allowing for an open rigid bronchoscope to facilitate ease of moving tools in and out of the airway. Despite a patient population that often suffers from significant respiratory compromise, major complications with rigid bronchoscopy are uncommon and are similar among modern ventilation approaches. Choice of ventilation technique should be determined by local expertise and equipment availability. Appropriate patient selection and recognition of limitations associated with a given ventilation strategy are critical to avoid procedural-related complications.

High-Frequency Jet Ventilation (HFJV) is a specific modality of mechanical ventilation employed in certain operative and critical care settings. Despite its technical advantages, particularly in procedures requiring minimal organ motion, HFJV remains underutilised in routine clinical practice, largely due to limited high-quality evidence and the absence of formal national guidelines. This systematic review aims to critically appraise the current evidence regarding the safety and efficacy of HFJV in adult and paediatric patients. The analysis covers both operating room and intensive care unit settings, and compares HFJV with conventional ventilation strategies. A comprehensive literature search was conducted in accordance with PRISMA guidelines. We included 41 studies published after 1997, which were appraised using the Oxford Centre for Evidence-Based Medicine (OCEBM) levels of evidence and Cochrane risk-of-bias tools (RoB 2 and ROBINS-I). Most studies demonstrated favourable physiological and procedural outcomes with HFJV in intraoperative settings, The benefits were most notable during airway surgeries, tissue ablation procedures, and atrial fibrillation ablation.. In contrast, results in neonatal intensive care were heterogeneous, with some studies reporting improved gas exchange, while others indicated higher complication or mortality rates. Common limitations included small sample sizes, methodological heterogeneity, and risk of selection and publication bias. Volatile anaesthetic delivery was universally unfeasible, and HFJV performance was reduced in obese or COPD patients. This review underscores the need for further research to optimise HFJV application and to better understand its long-term clinical impacts. The insights gained provide valuable guidance for future clinical use. [Display omitted] •Systematic review of the safety and efficacy of HFJV in adults and children.•Addresses risks such as pneumothorax and challenges in parameter control.•Provides evidence-based recommendations for HFJV use in clinical contexts.

To investigate post-procedural recovery as well as peri-procedural respiratory and hemodynamic safety parameters with prolonged use of high-frequency jet ventilation (HFJV) versus conventional ventilation in patients undergoing catheter ablation for atrial fibrillation. Hospital registry study. Tertiary academic teaching hospital in New England. 1822 patients aged 18 years and older undergoing catheter ablation between January 2013 and June 2020. HFJV versus conventional mechanical ventilation. The primary outcome was post-anesthesia care unit (PACU) length of stay. In secondary analyses we assessed the effect of HFJV on intra-procedural hypoxemia, defined as the occurrence of peripheral hemoglobin oxygen saturation (SpO2) <90%, post-procedural respiratory complications (PRC) as well as intra-procedural hypocarbia and hypotension. Multivariable negative binomial and logistic regression analyses, adjusted for patient and procedural characteristics, were applied. 1157 patients (63%) received HFJV for a median (interquartile range [IQR]) duration of 307 (253–360) minutes. The median (IQR) length of stay in the PACU was 244 (172–370) minutes in patients who underwent ablation with conventional mechanical ventilation and 226 (163–361) minutes in patients receiving HFJV. In adjusted analyses, patients undergoing HFJV had a longer PACU length of stay (adjusted absolute difference: 37.7 min; 95% confidence interval [CI] 9.7–65.8; p = 0.008). There was a higher risk of intra-procedural hypocarbia (adjusted odds ratio [ORadj] 5.90; 95%CI 2.63–13.23; p < 0.001) and hypotension (ORadj 1.88; 95%CI 1.31–2.72; p = 0.001) in patients undergoing HFJV. No association was found between the use of HFJV and intra-procedural hypoxemia or PRC (p = 0.51, and p = 0.97, respectively). After confounder adjustment, HFJV for catheter ablation procedures for treatment of atrial fibrillation was associated with a longer length of stay in the PACU. It was further associated with an increased risk of intra-procedural abnormalities including abnormal carbon dioxide homeostasis, as well as intra-procedural arterial hypotension. [Display omitted] •High-Frequency Jet Ventilation (HFJV) is associated with intra-procedural catheter stability and reduced disease recurrence.•Limited evidence exists on the peri-procedural safety of prolonged HFJV.•HFJV was associated with an extended recovery time by about 38 min longer stay in the post-anesthesia care unit.•Patients receiving HFJV were at higher risk of intraoperative hypocarbia and hypotension.

High frequency jet ventilation (HFJV) can be used to minimise sub-diaphragmal organ displacements. Treated patients are in a supine position, under general anaesthesia and fully muscle relaxed. These are factors that are known to contribute to the formation of atelectasis. The HFJV-catheter is inserted freely inside the endotracheal tube and the system is therefore open to atmospheric pressure. The aim of this study was to assess the formation of atelectasis over time during HFJV in patients undergoing liver tumour ablation under general anaesthesia. In this observational study twenty-five patients were studied. Repeated computed tomography (CT) scans were taken at the start of HFJV and every 15 minutes thereafter up until 45 minutes. From the CT images, four lung compartments were defined: hyperinflated, normoinflated, poorly inflated and atelectatic areas. The extension of each lung compartment was expressed as a percentage of the total lung area. Atelectasis at 30 minutes, 7.9% (SD 3.5, p = 0.002) and at 45 minutes 8,1% (SD 5.2, p = 0.024), was significantly higher compared to baseline 5.6% (SD 2.5). The amount of normoinflated lung volumes were unchanged over the period studied. Only a few minor perioperative respiratory adverse events were noted. Atelectasis during HFJV in stereotactic liver tumour ablation increased over the first 45 minutes but tended to stabilise with no impact on normoinflated lung volume. Using HFJV during stereotactic liver ablation is safe regarding formation of atelectasis.

Normal frequency jet ventilation (NFJV) is commonly used during rigid bronchoscopy; however, airway opening does not reliably measure or predict tidal volume (V T ) or peak inspiratory pressure (PIP). This study aimed to investigate the comprehensive effects on V T and PIP concerning key variables, including driving pressure (DP pipeline ), frequency (F jet ), needle inner diameter (ID needle ), and lung dynamic compliance (C dyn ). Three jet needles (N 1 , N 2 , and N 3 ) with different internal diameters (1.2–1.9 mm) were used to deliver jet ventilation via a rigid bronchoscope at DPs of 0.6–1.6 bar and frequencies of 10–60 min⁻¹. Airway pressure (Paw) was measured near the tracheal prominence of the simulated lung. Expiratory gas flow was diverted into a dedicated collection chamber fitted with a solenoid valve over a one-minute period, and the collected volume was measured as minute volume (MV). ①. Statistical analysis of the two lung models revealed consistent findings: both V T and PIP values in N 2 and N 3 demonstrated statistically significant differences compared to N 1 ( P  < 0.05). Additionally, significant differences in the V T and PIP values were observed between N 2 and N 3 ( P  < 0.05). ②. Multiple linear regression analyses indicated that DP pipeline , F jet , and ID needle had statistically significant effects on V T and PIP ( P  < 0.05). Conversely, C dyn significantly affected V T ( P  < 0.05) but did not have a significant impact on PIP ( P  > 0.05). The primary variables exerting a significant influence on V T and PIP were DP pipeline , F jet , and ID needle . Furthermore, C dyn significantly affected V T but not PIP. V T and PIP can be accurately predicted using regression equations.

Nasal cannulas and face masks are common oxygenation tools used in conventional oxygen therapy for patients undergoing endoscopic surgery with sedation. However, as a novel supraglottic ventilation technique, the application of supraglottic jet oxygenation and ventilation (SJOV) in endoscopic surgery has not been well established. We searched six electronic databases from inception to January 16, 2024, to assess the oxygenation/ventilation efficacy and side effects of the of SJOV in endoscopic surgery. The primary outcome was the incidence of hypoxemia. The secondary outcomes were the incidence of respiratory depression and adverse effects (nasal bleeding, sore throat, and dry mouth). Nine trials involving 2017 patients were included. The results demonstrated that the incidence of hypoxemia was lower in the SJOV group compared with the conventional oxygen therapy (COT) group [9 trails; 2017 patients; risk ratio (RR) = 0.18; 95% confidence interval (CI), (0.11–0.28)]. Subgroup analyses showed that SJOV reduced the incidence of hypoxemia in the high-risk group but had no effect on the low-risk group. The incidence of respiratory depression is lower in SJOV than in COT, but has increased side effects such as dry mouth. There was no statistically significant difference in nose bleeding or sore throat between the two groups. Compared with the COT, the SJOV decreased the incidence of hypoxemia in high-risk patients during endoscopic surgery with sedation. There was an increased risk of dry mouth, but not of nose bleeding or sore throat, during endoscopic surgery under sedation. •Compared with COT, there was a significantly reduction of intraoperative hpoxemia during endoscopic surgery with SJOV.•SJOV can decrease the incidence of hypoxemia, especially in high-risk patients during the endoscopic surgery with sedation.•There was no increased risk of nose bleeding or sore throat between SJOV and COT group, except for dry mouth.

Background/aim This study evaluated the efficacy of high-frequency jet ventilation (HFJV) using a silicone catheter in patients undergoing rigid bronchoscopy (RB). Materials and methods Following necessary approval for a retrospective clinical and experimental study, the data of patients who underwent HFJV using a silicone catheter during RB under general anesthesia through interventional pulmonology (IP) between January 2024 and August 2024 were analyzed. Prior to the study, flow/thermography tests were conducted to assess the efficacy of the silicone catheter. Arterial blood gas (ABG) analysis before, during, and after anesthesia as well as patient hemodynamic and oxygen saturation (SpO 2 ) data recorded during the procedure were evaluated. Patients were observed for up to 24 h following the procedure. The procedure included the following steps: (1) HFJV application with Evone ® (Ventinova, Eindhoven, Netherlands) ventilator after intubation with an orotracheal silicone catheter; (2) HFJV termination and manual ventilation (MV) application in cases of hypoxia, hypercapnia, and hemodynamic instability; (3) flow-controlled ventilation (FCV) with a laryngeal mask or tracheal intubation in patients who cannot be managed with MV; and (4) close hemodynamic monitoring as well as ABG analysis during the procedure. Result A total of 25 patients were included in the study. The median duration of the procedure was 35 min. In 21 (84%) patients, the procedure was successfully performed with HFJV using a silicone ventilation catheter. In these successful cases, the hemodynamic parameters and ABG values remained within normal limits throughout the procedure. The median values of arterial oxygen partial pressure (PaO 2 ), arterial carbon dioxide partial pressure (PaCO 2 ), SpO 2 , and pH were 210 mmHg, 41.6 mmHg, 99.4%, and 7.37, respectively, when considering the worst ABG values during the procedure. Hypoxia (SpO 2  < 90%) was detected in 4% ( n  = 1) of patients, while hypercarbia (PaCO 2  ≥ 50 mmHg) was observed in 16% ( n  = 4). The utilization of a Y-stent was necessary in one patient (4%). One patient (4%) experienced severe bleeding during the resection process, and one (4%) patient underwent orotracheal intubation. Postoperative pulmonary complications or adverse events were not observed in any patient. Conclusion The findings of the present study demonstrated that the utilization of silicone catheters in conjunction with HFJV is both safe and efficacious for IP and RB procedures. These results suggest that HFJV with a silicone catheter may be a viable option in RB procedures. Clinical trial number It cannot be applicable because it is a retrospective study.