Multi‐Institutional Analysis of Outcomes in Supraglottic Jet Ventilation with a Team‐Based Approach

Abstract

Objectives/Hypothesis: To evaluate the safety and complications of endoscopic airway surgery using supraglottic jet ventilation with a team-based approach.Study Design: Retrospective cohort study.Methods: Subjects at two academic institutions diagnosed with laryngotracheal stenosis who underwent endoscopic airway surgery with jet ventilation between January 2008 and December 2018 were identified. Patient characteristics (age, gender, race, follow-up duration) and comorbidities were extracted from the electronic health record. Records were reviewed for treatment approach, intraoperative data, and complications (intraoperative, acute postoperative, and delayed postoperative).Results: Eight hundred and ninety-four patient encounters from 371 patients were identified. Intraoperative complications (unplanned tracheotomy, profound or severe hypoxic events, barotrauma, laryngospasm) occurred in fewer than 1% of patient encounters. Acute postoperative complications (postoperative recovery unit [PACU] rapid response, PACU intubation, return to the emergency department [ED] within 24 hours of surgery) were rare, occurring in fewer than 3% of patient encounters. Delayed postoperative complications (return to the ED or admission for respiratory complaints within 30 days of surgery) occurred in fewer than 1% of patient encounters. Diabetes mellitus, active smoking, and history of previous tracheotomy were independently associated with intraoperative, acute, and delayed complications.Conclusions: Employing a team-based approach, jet ventilation during endoscopic airway surgery demonstrates a low rate of complications and provides for safe and successful surgery.

Low Pressure Low Frequency Jet Ventilation: Techniques, Safety and Complications

“…Conversely, Philips et al 20 showed that JV was successful in obese patients and there was no significant difference in the need for intraoperative intubation between obese patients and the non-obese cohort. Rodney et al 16 study also did not demonstrate higher BMI increased jet ventilation complication. Therefore, all of these studies showed that JV is feasible and safe in obese and morbidly obese patients.…”

“…21 We also noted that cases that required intubation had longer surgery duration compared to cases that did not require intubation. Similarly, Rodney et al 16 study demonstrated that jet ventilation complications were associated with longer operative time.…”

“…Another complication which may be associated with jet ventilation was unplanned tracheostomy due to could not ventilate could not intubate scenario. Rodney et al 16 study reported 3 cases of unplanned tracheostomy in their study. Fortunately, in our series, there were no cases of unplanned tracheostomy but surgeons utilizing jet ventilation should discuss this complication with patients and should always be prepared to handle this airway emergency by having a tracheostomy tray readily accessible.…”

“…In reviewing the literature, most JV studies reported cases with less than 200 patients. Only the studies by Crockett et al, 9 Hu et al, 15 and Rodney et al 16 had a similar number of cases with populations of 872, 839, and 894 respectively. However, Crockett et al 9 had 78% pediatric cases, while fewer than 1% (4/981) of the cases included in this study were patients under the age of 18.…”

“…The Hu et al 15 series of 839 cases resulted in 2 instances of barotrauma, 1 case with pneumopericardium and another with pneumothorax. Rodney et al 16 multi-institutional analysis had one instance of intraoperative pneumothorax (N=894) from two centers utilizing average jet pressure at either 20 psi or 24 psi. They did not discuss which institution had the pneumothorax nor the root cause.…”