High-frequency jet ventilation in endolaryngeal surgery.

STUDY OBJECTIVE: To describe the clinical experience with high-frequency jet ventilation (HFJV) of the lungs during endolaryngeal surgery and its effect on acid-base balance and capillary PO2 (PcO2), PCO2, central hemodynamics, and tracheobronchial mucous membrane. DESIGN: Evaluation of different modalities of HFJV. SETTING: Operating rooms and otolaryngology intensive care unit in a medical institute. PATIENTS: 218 patients undergoing elective endolaryngeal surgery. INTERVENTIONS: Patients receive HFJV through catheters with an inner diameter of 1.4 to 1.8 mm. Catheters were introduced orotracheally, nasotracheally, percutaneously, or through a fenestrated tracheostomy tube. Minute volume was based on body weight times 0.2, corrected for acid-base balance. MEASUREMENTS AND MAIN RESULTS: Intraoperative cardiac output, airway pressure, changes in tracheobronchial mucosa, and acid-base balance were monitored. HFJV changed central hemodynamics slightly and preserved gas exchange: PcCO2 remained within normal limits, while PcO2 increased. Use of thin catheters enhanced largyneal exposure and surgical manipulation. Percutaneous catheterization permitted resumption of HFJV in the event of laryngeal edema and inadequate spontaneous respiration after surgery. CONCLUSION: HFJV leads to optimal conditions for endolaryngeal surgery, reverses constant outflow of the respiratory gas mixture, prevents aspiration of tissue products and blood, and removes smoke from the operative site when using laser surgery.

[Provision of artificial ventilation of the lungs during endolaryngeal surgical interventions using a high-energy laser]. / Obespechenie iskusstvennoi ventiliatsii legkikh pri éndolaringeal'nykh khirurgicheskikh vmeshatel'stvakh s ispol'zovaniem vysokoénergeticheskogo lazera.

To ensure controlled lung ventilation in endolaryngeal surgical interventions, using a high-energy laser, use was made of normal frequency jet ventilation (NFJV) and high frequency jet ventilation (HFJV) through a non-inflammable fluoroplast catheter supplied at a distal end with a device fixing it in a central position. HFJV seems preferable, as endolaryngeal manipulations become more convenient. The study was performed in 118 patients. Venturi effect was observed only during ventilation through a tracheostomic canule. It has been established that, unlike NFJV, in HFJV gas exchange parameters are much better, though oxygenation in NFJV is satisfactory in all the patients.