Faculty, Staff and Student Publications

Language

English

Publication Date

3-1-2025

Journal

Journal of Clinical Anesthesia

DOI

10.1016/j.jclinane.2025.111773

PMID

39933243

Abstract

Objective: Test the hypothesis that the center of ventilation, a measure of ventro-dorsal atelectasis, is posterior during supraglottic ventilation indicating better dependent-lung ventilation. Secondarily, we tested the hypothesis that supraglottic ventilation improves oxygenation and carbon dioxide elimination.

Background: Supraglottic and subglottic jet ventilation are both used during laryngotracheal surgery. Supraglottic jet ventilation may better prevent atelectasis and provide superior ventilation.

Design: Randomized, cross-over trial.

Setting: Operating rooms.

Patients: Patients having elective micro-laryngotracheal surgery.

Interventions: Patients were sequentially ventilated for 5 min with one randomly selected type of jet ventilation before being switched to the alternative method.

Measurements: Regional ventilation distribution was estimated using electrical impedance tomography, with arterial oxygenation and carbon dioxide partial pressures being simultaneously evaluated.

Results: Thirty patients completed the study. There were no statistically significant or clinically meaningful differences in the center of ventilation with supraglottic and subglottic ventilation. However, ventilation with the supraglottic approach was about 4 % higher in the ventromedial lung region and about 4 % lower in the dorsal lung. Surprisingly, arterial blood oxygenation was considerably worse with supraglottic (173 [156, 199] mmHg) than subglottic ventilation (293 [244, 340] mmHg). Arterial carbon dioxide partial pressure was near 40 mmHg with each approach, although slightly lower with supraglottic jet ventilation.

Conclusion: The center of ventilation distribution, a measure of atelectasis, was similar with supraglottic and subglottic jet ventilation. Subglottic jet ventilation improved the dorsal-dependent lung region and provided superior arterial oxygenation. Both techniques effectively eliminated carbon dioxide, with the supraglottic approach demonstrating slightly superior efficacy.

Keywords

Humans, Cross-Over Studies, Male, Female, High-Frequency Jet Ventilation, Middle Aged, Pulmonary Atelectasis, Adult, Oxygen, Carbon Dioxide, Aged, Larynx, Glottis, Trachea, Lung, Electric Impedance, Anesthesia, Center of ventilation, Electrical impedance tomography, Jet ventilation, Laryngotracheal surgery, Regional lung ventilation distribution, Subglottic jet ventilation, Supraglottic jet ventilation, Tidal impedance variation

Comments

Trial registration: ClinicalTrials.gov NCT03973294.

Published Open-Access

yes

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