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Tag: Anaesth Crit Care Pain Med

Rescue Transtracheal Jet Ventilation during difficult intubation in patients with upper airway cancer.

By Kamruz Zaman
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Rescue Transtracheal Jet Ventilation during difficult intubation in patients with upper airway cancer.

Anaesth Crit Care Pain Med. 2017 Nov 10;:

Authors: Bouroche G, Motamed C, de Guibert JM, Hartl D, Bourgain JL

Abstract
INTRODUCTION: The failure rates of intubation and/or mask ventilation are higher in patients with neck or upper airway disease. To ensure oxygenation, Rescue Trans-Tracheal Jet ventilation (RTTJV) may be used. In this critical situation, a high rate of complications has been reported. The aim of this study was to report RTTJV performed by a jet ventilator with an end-expiratory pressure control in an experienced institution.
PATIENTS AND METHODS: From a computerised database of 63905 anaesthesia cases, the anaesthetic reports of patients who underwent emergency RTTJV during intubation were studied retrospectively. The following information were analysed: anaesthetic procedures, data from the monitoring: lowest SpO2, duration of SpO2 < 90%, and complications. Success of emergency RTTJV was defined when SpO2 was > 90% under jet ventilation.
RESULTS: RTTJV was used in 31 patients, of whom 26 had upper airway cancer, (pre-treatment, n=9, post-treatment, n=17). Difficult intubation was anticipated in 15 out of 31 cases including six fiberoptic-aided intubations under spontaneous ventilation. RTTJV was effective in all cases with quick restoration of oxygenation (SpO2 > 90%). During jet-ventilation, final airway control was performed either by oral intubation (n=25) or tracheotomy (n=1) in a short delay (mean: 8.1±1.7min). Subcutaneous emphysema was observed in one case without pneumothorax.
CONCLUSION: RTTJV with end-expiratory pressure control allowed oxygenation during difficult intubation, with a low rate of complications.

PMID: 29133271 [PubMed – as supplied by publisher]