[High Frequency Jet Ventilation and laryngeal surgery, clinical practice].

High Frequency Jet Ventilation is one in a group of alternative ventilatory techniques characterized by the application of small tidal volumes delivered at higher than physiological rates, followed by the passive expiration. There are two groups of indications: first, High Frequency Jet ventilation was used as a special ventilation mode during diagnostic or surgical procedures in patients with airway pathology; and second, High Frequency Jet Ventilation was employed as a respiratory support technique to improve gas exchange during severe pulmonary failure in infants, children and adults. Diagnostic or surgery laryngoscopy requires a method that can give good exposure of the larynx, continuing control of the airway patency and immobility of the vocal cords. High frequency Jet Ventilation overcomes the disadventage of an anaesthetic technique using a tracheal tube which can hide the posterior part of the glottis and which carries the risk of the fire in the airway. Small plastic cannulae have been introduced by the nasotracheal, orotracheal or transtracheal route for supraglottic or subglottic application of jet streams, employing tubeless HFJV. Jet ventilation via a catheter placed through the cricothyroid membrane, is an easy and safe way to ventilate patients with an abnormality of the upper airway, such as in cases of head and neck cancer. Inappropriate airway pressure monitoring and/or an insufficient expiratory airflow enhances the risk of pulmonary barotrauma. Despite a large body of published evidence describing its benefits as an alternative ventilatory approach in anaesthesia and intensive care medicine, its application has not gained widespread acceptance and is restricted to specialized centres only.