Supraglottic jet oxygenation and ventilation assisted fiberoptic intubation in a paralyzed patient with morbid obesity and obstructive sleep apnea: a case report

Liang, Hansheng; Hou, Yuantao; Wei, Huafeng; Feng, Yu

doi:10.1186/s12871-019-0709-7

Cited by 11 publications

(9 citation statements)

References 25 publications

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“…The intermittent powerful jet pulses are able to reduce CO 2 washout and CO 2 dilution 33 from the jet flow, and provide acute measurement of P ET CO 2 , as demonstrated by previous studies. 23 , 34 – 36 Respiratory depression or apnoea can be detected effectively, while simultaneously monitoring the effectiveness of SJOV during moderate-to-deep sedation. Additional airway assistance may be provided to prevent the occurrence of hypoxaemia and accumulation of CO 2 during SJOV.…”

Section: Discussionmentioning

confidence: 99%

Supraglottic jet oxygenation and ventilation reduces desaturation during bronchoscopy under moderate to deep sedation with propofol and remifentanil

Zha

Xie

et al. 2020

European Journal of Anaesthesiology

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BACKGROUND Hypoxaemia is frequently seen during flexible bronchoscopies that are done with a nasal approach under the traditional sedation with propofol. This study investigated the potential benefits of supraglottic jet oxygenation and ventilation (SJOV) using the Wei nasal jet tube (WNJ) in reducing hypoxaemia in patients undergoing bronchoscopy under moderate to deep intravenous sedation using a propofol, lidocaine and remifentanil cocktail. OBJECTIVES Our primary objective was to evaluate the efficacy and complications of SJOV via the WNJ during flexible bronchoscopy under moderate to heavy sedation with propofol and remifentanil. DESIGN A randomised controlled clinical trial. SETTING The 180th Hospital of People's Liberation Army, Quanzhou, China, from 1 June to 1 November 2019. PATIENTS A total of 280 patients aged ≥18 years with American Society of Anesthesiologists’ physical status 1 to 3 undergoing flexible bronchoscopy were studied. INTERVENTIONS Patients were assigned randomly into one of two groups, a nasal cannula oxygenation (NCO) group ( n = 140) using a nasal cannula to deliver oxygen (4 l min −1 ) or the SJOV group ( n = 140) using a WNJ connected to a manual jet ventilator to provide SJOV at a driving pressure of 103 kPa, respiratory rate 20 min −1 , F i O 2 1.0 and inspiratory:expiratory (I:E) ratio 1:2. MAIN OUTCOME MEASURES The primary outcome was an incidence of desaturation (defined as SpO 2 < 90%) during the procedure. Other adverse events related to the sedation or SJOV were also recorded. RESULTS Compared with the NCO group, the incidence of desaturation in the SJOV group was lower (NCO 37.0% vs. SJOV 13.1%) ( P < 0.001). Patients in the SJOV group had a higher incidence of a dry mouth at 1 min (13.1% vs. 1.5%, P < 0.001) than at 30 min (1.5% vs. 0%, P = 0.159) or at 24 h (0% vs. 0%). There was no significant difference between the groups in respect of sore throat, subcutaneous emphysema or nasal bleeding. CONCLUSIONS SJOV via a WNJ during flexible bronchoscopy under moderate to deep sedation with propofol and remifentanil significantly reduces the incidence of desaturation when compared with regular oxygen supplementation via a nasal cannula. Patients in the SJOV group had an increased incidence of transient dry mouth. TRIAL REGISTRATION Registered at www.chictr.org.cn (ChiCTR1900023514).

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Section: Discussionmentioning

confidence: 99%

Supraglottic jet oxygenation and ventilation reduces desaturation during bronchoscopy under moderate to deep sedation with propofol and remifentanil

Zha

Xie

et al. 2020

European Journal of Anaesthesiology

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“…Given the deeper sedation level and higher altitude, we assumed that 30% of patients in the nasal cannula oxygen supply group might encounter hypoxia, which was still within the reported range [ 12 , 14 ] and consistent with our unpublished preliminary data. Considering the ventilation competence of SJOV [ 5 , 11 , 16 ], the incidence of hypoxia might not deviate from the reported rate (3%). We assumed an incidence of 5% in the SJOV group, which corresponded to an absolute difference of 25% between the groups.…”

Section: Methodsmentioning

confidence: 96%

“…In the SJOV group, SJOV was conducted using a Wei nasal jet tube (WNJ, Well Lead Medical Co. Ltd., Guangzhou, China), which was connected to a manual jet ventilator (Well Lead Medical Co. Ltd., Guangzhou, China) via its jet port (Fig. 1 ) [ 8 , 11 ]. The initial settings of SJOV were as follows: driving pressure (DP) 15 psi; respiratory rate (RR) 20 bpm; inspiratory-to-expiratory (I/E) ratio 1:2, and gas supply, 100% oxygen [ 8 ].…”

Section: Methodsmentioning

confidence: 99%

Supraglottic jet oxygenation and ventilation decreased hypoxemia during gastrointestinal endoscopy under deep sedation at high altitudes: a randomized clinical trial

Jiang

Ciren

et al. 2022

BMC Anesthesiol

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Background Hypobaric hypoxia is common at high altitudes. Whether this exacerbates hypoxia during procedural sedation and whether hypoxia can be alleviated by the use of supraglottic jet oxygenation and ventilation (SJOV) are unknown. This study aimed to compare the incidence of hypoxia during gastrointestinal endoscopy under deep sedation at high altitudes with oxygen supply techniques using either a nasal cannula or SJOV. Methods This study was conducted from April 2022 to July 2022 in a tertiary hospital located 3650 m above sea level. Adult patients scheduled for routine gastrointestinal endoscopy under sedation were enrolled and randomized 1:1 to receive SJOV or a nasal cannula during sedation. Moderate hypoxia was the primary outcome, defined as an SPO2 of 75–89% for < 60 s. The secondary outcomes were respiratory-, cardiovascular-, and SJOV-related complications. The influence of characteristics regarding acclimatization to high altitudes (Tibetan ethnic group and erythrocytosis) on the occurrence of hypoxia was analyzed. Results None of the patients were lost to follow-up. A total of 72 patients were included in the analysis (36 patients in each group). There were 20 (27.8%) patients who experienced moderate hypoxia events. Significantly fewer hypoxic events occurred in the SJOV group than in the nasal cannula group [3 (8.3%) vs. 17 (47.2%), absolute risk difference (95% CI): − 38.9 (− 57.5, − 20.2) %, risk ratio (RR, 95% CI): 0.18 (0.06, 0.55), P < 0.001]. Significantly fewer patients in the SJOV group experienced mild hypoxia (P < 0.001) and severe hypoxia (P = 0.002). No serious adverse events occurred in either of the groups. The Tibetan ethnic group (P = 0.086) and erythrocytosis (P = 0.287) were not associated with the occurrence of hypoxia events. Conclusions The incidence of hypoxia was lower with SJOV than with nasal cannula in patients undergoing gastrointestinal endoscopy under deep sedation at high altitudes. The Tibetan ethnic group and erythrocytosis did not influence the occurrence of hypoxia. Trial registration This study was registered at ClinicalTrials.gov (NCT05304923) before enrollment by Dr. Yi Feng on 31/03/2022.

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“…Due to its comfort and simplicity of wearing, endoscopic face masks are more widely used in clinical practice. The Wei Nasal Jet ® (WNJ) tube is a newly invented 2-wall nasal airway for supraglottic jet oxygenation and ventilation (SJOV) and end-tidal partial pressure of carbon dioxide (CO 2 ) monitoring [9][10][11][12]. Its inner diameter is 5.0 mm, outer diameter is 7.5 mm, and length is 18 cm.…”

Section: Introductionmentioning

confidence: 99%

“…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].…”

Section: Introductionmentioning

confidence: 99%

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

Yang¹,

Wei

Hou³

et al. 2022

Med Sci Monit

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is the inventor of the Wei Nasal Jet Tube (Wei Nasal Jet or WNJ), which was used to generate SJOV in this study Conflict of interest:None declared Background:The Twinstream ® ventilator is a microprocessor-controlled electric jet ventilator that allows the simultaneous application of 2 different jet streams, one at low frequency and one at high frequency to result in pulsatile bilevel (p-BLV) mode of ventilation. This study aimed to evaluate supraglottic jet oxygenation and ventilation in 105 patients during bronchoscopy using the Twinstream ® microprocessor-controlled jet ventilator and the Wei Nasal Jet ® (WNJ) tube. Material/Methods:Patients were randomly divided into 2 parallel groups (N=50 per group): group W using the WNJ tube and group M using an endoscopic face mask connected to Twinstream ® microprocessor-controlled jet ventilator under monitored anesthesia care. Arterial blood gas was examined and recorded 15 minutes after the initiation of procedure. The demographic and clinical characteristics, procedure duration, doses of anesthetics, and adverse events in the 2 groups were also recorded. Results:The arterial partial pressure of carbon dioxide (PaCO 2 ) (P=0.006) and lactic acid (P=0.001) were significantly lower, while pH (P=0.024) was significantly higher than in the group M. Pearson analysis showed that PaCO 2 was significantly correlated with ventilation tools (P=0.006) and procedure duration (P=0.003). Multiple linear regression analysis showed that ventilation tools and procedure duration were both independent influencing factors (P=0.006, P=0.002). Conclusions:Supraglottic jet oxygenation and ventilation using the WNJ tube can reduce PaCO 2 and had advantages in enhancing oxygenation and ventilation function in patients during bronchoscopy intervention therapy under monitored anesthesia care.

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Supraglottic jet oxygenation and ventilation assisted fiberoptic intubation in a paralyzed patient with morbid obesity and obstructive sleep apnea: a case report

Cited by 11 publications

References 25 publications

Supraglottic jet oxygenation and ventilation reduces desaturation during bronchoscopy under moderate to deep sedation with propofol and remifentanil

Supraglottic jet oxygenation and ventilation reduces desaturation during bronchoscopy under moderate to deep sedation with propofol and remifentanil

Supraglottic jet oxygenation and ventilation decreased hypoxemia during gastrointestinal endoscopy under deep sedation at high altitudes: a randomized clinical trial

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

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