Journal Article

Regional lung ventilation during supraglottic and subglottic jet ventilation: A randomized cross-over trial

Plattner, Olga, Prusak, Michal, Sessler, Daniel I., Roesner, Imme, Denk-Linnert, Doris-Maria, Gemeiner, Jana, Wang, Lu, Edlinger-Stanger, Maximilian, Kaniusas, Eugenijus, Khattab, Ahmed, Windpassinger, Marita

2025

Overview

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.

• Publisher: Elsevier Inc,Elsevier Limited
• Subject: Adult / Aged / Airway management / Anesthesia / Carbon dioxide / Carbon Dioxide - blood / Catheters / Center of ventilation / Cross-Over Studies / Electric Impedance / Electrical impedance tomography / Electrodes / Female / Glottis / High-Frequency Jet Ventilation - adverse effects / High-Frequency Jet Ventilation - methods / Humans / Hypotheses / Hypoxia / Jet ventilation / Laryngoscopy / Laryngotracheal surgery / Larynx - surgery / Lung - physiology / Lungs / Male / Middle Aged / Oxygen - blood / Pain Medicine / Perioperative care / Pulmonary Atelectasis - etiology / Pulmonary Atelectasis - prevention & control / Regional lung ventilation distribution / Regions / Subglottic jet ventilation / Supraglottic jet ventilation / Surgery / Thorax / Tidal impedance variation / Tomography / Trachea - surgery / Ventilation / Ventilators