Department of anaesthesia, institut Gustave-Roussy, 94800 Villejuif, France.
Department of anaesthesia, institut Gustave-Roussy, 94800 Villejuif, France.
Anaesth Crit Care Pain Med. 2018 Dec;37(6):539-544. doi: 10.1016/j.accpm.2017.10.005. Epub 2017 Nov 10.
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.
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 SpO, duration of SpO<90%, and complications. Success of emergency RTTJV was defined when SpO was>90% under jet ventilation.
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 (SpO>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±1.7min). Subcutaneous emphysema was observed in one case without pneumothorax.
RTTJV with end-expiratory pressure control allowed oxygenation during difficult intubation, with a low rate of complications.
在患有颈部或上呼吸道疾病的患者中，插管和/或面罩通气失败的发生率更高。为了确保氧合，可能需要使用紧急经气管喷射通气（RTTJV）进行抢救。在这种危急情况下，已经报道了很高的并发症发生率。本研究的目的是报告在经验丰富的机构中使用带呼气末压力控制的喷射通气机进行 RTTJV 的情况。
从 63905 例麻醉病例的计算机数据库中，回顾性研究了在插管期间进行紧急 RTTJV 的患者的麻醉报告。分析了以下信息：麻醉程序、监测数据：最低 SpO2、SpO2<90%的持续时间以及并发症。当喷射通气下 SpO2>90%时，将紧急 RTTJV 定义为成功。
在 31 名患者中使用了 RTTJV，其中 26 名患有上呼吸道癌（治疗前，n=9；治疗后，n=17）。预计 31 例中有 15 例存在插管困难，包括 6 例在自主通气下进行纤维光学辅助插管。所有病例的 RTTJV 均有效，氧合迅速恢复（SpO2>90%）。在喷射通气期间，最终气道控制通过口腔插管（n=25）或气管切开术（n=1）在短时间延迟内完成（平均：8.1±1.7 分钟）。一例皮下气肿，但无气胸。
带呼气末压力控制的 RTTJV 可在困难插管期间实现氧合，并发症发生率低。
