Rescue transtracheal jet ventilation during difficult intubation in patients with upper airway cancer

Introduction: The failure rates of intubation and/or mask ventilation are higher in patients with neck or upper airway disease. To ensure oxygenation, rescue trans-tracheal jet ventilation (RTTJV) may be used. In this critical situation, a high rate of complications has been reported. The aim of this study was to report RTTJV performed by a jet ventilator with an end-expiratory pressure control in an experienced institution. Patients and methods: From a computerised database of 63,905 anaesthesia cases, the anaesthetic reports of patients who underwent emergency RTTJV during intubation were studied retrospectively. The following information were analysed: anaesthetic procedures, data from the monitoring: lowest SpO₂, duration of SpO₂ < 90%, and complications. Success of emergency RTTJV was defined when SpO₂ was > 90% under jet ventilation. Results: RTTJV was used in 31 patients, of whom 26 had upper airway cancer, (pre-treatment, n = 9, post-treatment, n = 17). Difficult intubation was anticipated in 15 out of 31 cases including six fiber-optic-aided intubations under spontaneous ventilation. RTTJV was effective in all cases with quick restoration of oxygenation (SpO₂ > 90%). During jet ventilation, final airway control was performed either by oral intubation (n = 25) or tracheotomy (n = 1) in a short delay (mean: 8.1 ± 1.7 min). Subcutaneous emphysema was observed in one case without pneumothorax. Conclusion: RTTJV with end-expiratory pressure control allowed oxygenation during difficult intubation, with a low rate of complications.