Percutaneous Transtracheal Jet Ventilation in Head and Neck Surgery | Critical Care Medicine | JAMA Otolaryngology–Head & Neck Surgery | JAMA Network
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Original Article
October 2005

Percutaneous Transtracheal Jet Ventilation in Head and Neck Surgery

Author Affiliations

Author Affiliations: Division of Otolaryngology–Head and Neck Surgery (Dr Spiro), University of Connecticut School of Medicine (Mr Gulleth), Farmington.

Arch Otolaryngol Head Neck Surg. 2005;131(10):886-890. doi:10.1001/archotol.131.10.886

Objective  To assess the safety and efficacy of percutaneous transtracheal jet ventilation (PTJV) in the management of the difficult airway.

Design  Retrospective case series.

Setting  Academic, tertiary care medical center.

Patients  Forty-three consecutive PTJV procedures performed on 33 patients with anticipated airway difficulty undergoing direct laryngoscopy for diagnosis and/or treatment of head and neck cancer (91%) or benign lesions.

Main Outcome Measures  Duration of PTJV, oxygen saturation values by pulse oximetry, and incidence of tracheotomy and complications.

Results  The mean duration of PTJV was 43 minutes, and mean minimum oxygen saturation was 97%. Biopsy was performed in 27 (62%) of the cases, and a laser excision in 12 (28%). Seven tracheotomies were planned preoperatively, and 2 were performed intraoperatively. Two additional patients required tracheotomies in the immediate postoperative period. Two (5%) complications occurred: 1 pneumothorax that resolved with chest tube insertion and 1 kinked catheter resulting in soft tissue emphysema that resolved spontaneously.

Conclusions  Percutaneous transtracheal jet ventilation is a safe and effective method of ventilation in patients with anticipated airway difficulty. It is particularly useful in patients who are not in immediate airway distress preoperatively but who may be difficult or impossible to intubate after induction of general anesthesia. Percutaneous transtracheal jet ventilation may help to avoid tracheotomy in this setting and should be routinely available as an option for airway management in patients with head and neck cancer.