High frequency jet ventilation through mask contributes to oxygen therapy among patients undergoing bronchoscopic intervention under deep sedation

Abstract

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 (FiO2) of 1.0, 12 L/min), the NFJV group (FiO2 of 1.0, driving pressure of 0.1 MPa, and respiratory rate (RR) 15 bpm) and the HFJV Group (FiO2 of 1.0, driving pressure of 0.1 MPa, and RR of 1200 bpm). Pulse oxygen saturation (SpO2), 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. PaO2 of the COT and NFJV groups was significantly lower than that of the HFJV group (P < 0.001). PaO2 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 PaO2 (P = 0.040 and P = 0.002, respectively). The location of airway lesions and the severity of airway stenosis were not statistically correlated with PaCO2 and PaO2. Conclusions HFJV could effectively and safely improve intra-operative PaO2 among patients with airway stenosis during BI in deep sedation, and it did not increase the intra-operative PaCO2 and the risk of hypercapnia. PaO2 was correlated with ventilation mode, BMI and procedure duration. Only BMI and procedure duration were independent influencing factors of arterial blood gas PaO2. PaCO2 was not correlated with any preoperative factor. Trial registration Chinese Clinical Trial Registry. Registration number, ChiCTR2000031110, registered on March 22, 2020.

Evaluation of Supraglottic Jet Oxygenation and Ventilation in 105 Patients During Bronchoscopy Using the Twinstream® Microprocessor-Controlled Jet Ventilator and the Wei Nasal Jet® Tube

“…In previous studies, SJOV via WNJ tube was found to reduce the incidence of intraoperative hypoxemia compared with nasal oxygen [ 10 , 12 ] and face mask oxygen [ 14 ]. A previous study found that use of an endoscopic face mask combined with SJOV improved oxygenation better than mask combined with high-flow oxygen [ 13 ]. Therefore, this study compared the oxygenation and ventilation function in SJOV via WNJ tube and endoscopic face mask during bronchoscopy intervention therapy under monitored anesthesia care.…”

“…Jet ventilation at high frequency can impair CO 2 elimination. Cheng and colleagues used an endoscopic mask in combination with high-frequency jet ventilation (HFJV) to supply oxygen for patients undergoing bronchoscopy intervention therapy and found that HFJV did not aggravate hypercapnia compared with normal frequency jet ventilation and conventional oxygenation [ 13 ].…”

“…SJOV is a minimally invasive technique of jet ventilation with the jet nozzle above the vocal cords and delivering high concentrations of oxygen with jet ventilation driving pressure [10]. It aims at improving oxygenation in patients with respiratory depression and is widely used in cases with difficult airways [6,[10][11][12][13][14][15][16][17].…”

Supraglottic Jet Oxygenation and Ventilation to Minimize Hypoxia in Patients Receiving Flexible Bronchoscopy Under Deep Sedation: A 3-Arm Randomized Controlled Trial

“…During endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) procedures, the incidence of hypoxia (peripheral oxygen saturation [Spo 2 ] < 90% for >5 seconds) has been reported as high as 56% when traditional nasal cannula oxygen (NCO) delivery at a flow rate of 4 L/min is used. 6 Several techniques have been researched to relieve hypoxia and deterioration of hypoventilation during the FB, [7][8][9][10][11] but there is still a risk of desaturation due to inadequate oxygenation and ventilation. Supraglottic jet oxygenation and ventilation (SJOV) is an emerging technique that uses a high-pressure jet pulse above the vocal cords to deliver oxygen and eliminate carbon dioxide.…”