Suria Stephanie, Galy Raphaëlle, Bordenave Lauriane, Motamed Cyrus, Bourgain Jean-Louis, Guerlain Joanne, Moya-Plana Antoine, Elmawieh Jamie
Department of Anesthesiology, Gustave Roussy, Paris-Saclay, F-94805 Villejuif, France.
Department of Cervico Facial Oncology, Gustave Roussy, Paris-Saclay, F-94805 Villejuif, France.
J Clin Med. 2023 Jun 14;12(12):4039. doi: 10.3390/jcm12124039.
Introduction-the upper airway panendoscopy, performed under general anesthesia, is mandatory for the diagnosis of cervicofacial cancer. It is a challenging procedure because the anesthesiologist and the surgeon have to share the airway space together. There is no consensus about the ventilation strategy to adopt. Transtracheal high frequency jet ventilation (HFJV) is the traditional method in our institution. However, the COVID-19 pandemic forced us to change our practices because HFJV is a high risk for viral dissemination. Tracheal intubation and mechanical ventilation were recommended for all patients. Our retrospective study compares the two ventilation strategies for panendoscopy: high frequency jet ventilation (HFJV) and mechanical ventilation with orotracheal intubation (MVOI). Methods-we reviewed all panendoscopies performed before the pandemic in January and February 2020 (HFJV) and during the pandemic in April and May 2020 (MVOI). Minor patients, patients with a tracheotomy before or after, were excluded. We performed a multivariate analysis adjusted on unbalanced parameters between the two groups to compare the risk of desaturation. Results-we included 182 patients: 81 patients in the HFJV group and 80 in the MVOI group. After adjustments based on BMI, tumor localization, history of cervicofacial cancer surgery, and use of muscle relaxants, the patients from the HFJV group showed significantly less desaturation than the intubation group (9.9% vs. 17.5%, OR = 0.18, = 0.047). Conclusion-HFJV limited the incidence of desaturation during upper airway panendoscopies in comparison to oral intubation.
引言——在全身麻醉下进行上气道全景内镜检查是诊断头颈部癌症的必要手段。这是一项具有挑战性的操作，因为麻醉医生和外科医生必须共同使用气道空间。对于采用何种通气策略尚无共识。经气管高频喷射通气（HFJV）是我们机构的传统方法。然而，新冠疫情迫使我们改变做法，因为HFJV存在病毒传播的高风险。建议对所有患者进行气管插管和机械通气。我们的回顾性研究比较了上气道全景内镜检查的两种通气策略：高频喷射通气（HFJV）和经口气管插管机械通气（MVOI）。方法——我们回顾了2020年1月和2月疫情前（HFJV）以及2020年4月和5月疫情期间（MVOI）进行的所有上气道全景内镜检查。排除未成年患者以及术前或术后行气管切开术的患者。我们对两组之间不平衡的参数进行多变量分析，以比较低氧饱和度风险。结果——我们纳入了182例患者：HFJV组81例，MVOI组80例。在根据体重指数、肿瘤位置、头颈部癌症手术史和肌肉松弛剂的使用情况进行调整后，HFJV组患者的低氧饱和度明显低于插管组（9.9%对17.5%，OR = 0.18，P = 0.047）。结论——与经口插管相比，HFJV可降低上气道全景内镜检查期间低氧饱和度的发生率。
