Windpassinger Marita, Prusak Michal, Gemeiner Jana, Edlinger-Stanger Maximilian, Roesner Imme, Denk-Linnert Doris-Maria, Plattner Olga, Khattab Ahmed, Kaniusas Eugenijus, Wang Lu, Sessler Daniel I
Department of Anaesthesia, Intensive Care Medicine and Pain Medicine, Division of General Anaesthesia and Intensive Care Medicine, Medical University of Vienna, Vienna, Austria; OutcomeResearch Consortium®, Houston, TX, USA.
Department of Anaesthesia, Intensive Care Medicine and Pain Medicine, Division of General Anaesthesia and Intensive Care Medicine, Medical University of Vienna, Vienna, Austria.
J Clin Anesth. 2025 Mar;102:111773. doi: 10.1016/j.jclinane.2025.111773. Epub 2025 Feb 10.
Test the hypothesis that the center of ventilation, a measure of ventro-dorsal atelectasis, is posterior during supraglottic ventilation indicating better dependent-lung ventilation. Secondarily, we tested the hypothesis that supraglottic ventilation improves oxygenation and carbon dioxide elimination.
Supraglottic and subglottic jet ventilation are both used during laryngotracheal surgery. Supraglottic jet ventilation may better prevent atelectasis and provide superior ventilation.
Randomized, cross-over trial.
Operating rooms.
Patients having elective micro-laryngotracheal surgery.
Patients were sequentially ventilated for 5 min with one randomly selected type of jet ventilation before being switched to the alternative method.
Regional ventilation distribution was estimated using electrical impedance tomography, with arterial oxygenation and carbon dioxide partial pressures being simultaneously evaluated.
Thirty patients completed the study. There were no statistically significant or clinically meaningful differences in the center of ventilation with supraglottic and subglottic ventilation. However, ventilation with the supraglottic approach was about 4 % higher in the ventromedial lung region and about 4 % lower in the dorsal lung. Surprisingly, arterial blood oxygenation was considerably worse with supraglottic (173 [156, 199] mmHg) than subglottic ventilation (293 [244, 340] mmHg). Arterial carbon dioxide partial pressure was near 40 mmHg with each approach, although slightly lower with supraglottic jet ventilation.
The center of ventilation distribution, a measure of atelectasis, was similar with supraglottic and subglottic jet ventilation. Subglottic jet ventilation improved the dorsal-dependent lung region and provided superior arterial oxygenation. Both techniques effectively eliminated carbon dioxide, with the supraglottic approach demonstrating slightly superior efficacy.
验证以下假设：作为腹背侧肺不张指标的通气中心，在声门上通气时位于后方，提示下垂肺通气更佳。其次，我们验证了声门上通气可改善氧合及二氧化碳清除的假设。
声门上及声门下喷射通气均用于喉气管手术。声门上喷射通气可能能更好地预防肺不张并提供更佳的通气效果。
随机交叉试验。
手术室。
择期进行微喉气管手术的患者。
患者先使用随机选择的一种喷射通气方式通气5分钟，然后换用另一种方式。
使用电阻抗断层扫描评估区域通气分布，并同时评估动脉氧合及二氧化碳分压。
30例患者完成研究。声门上通气与声门下通气在通气中心方面无统计学显著差异或临床意义上的差异。然而，声门上通气法在肺内侧区域的通气约高4%，而在肺背侧区域约低4%。令人惊讶的是，声门上通气时的动脉血氧合（173[156,199]mmHg）明显差于声门下通气（293[244,340]mmHg）。每种通气方式下动脉二氧化碳分压均接近40mmHg，不过声门上喷射通气时略低。
作为肺不张指标的通气中心分布，在声门上喷射通气与声门下喷射通气时相似。声门下喷射通气改善了下垂肺背侧区域的通气，并提供了更佳的动脉氧合。两种技术均能有效清除二氧化碳，声门上通气法的效果略优。
