Supraglottic jet ventilation in difficult airway management

Abstract

Background: Supraglottic jet ventilation (SJV) via the "jet endotracheal tube" (JET) designed by Wei (WEI JET; Wei Medical LLC, Cherry Hill, NJ) provides adequate oxygenation and ventilation during direct laryngoscopy and tracheal intubation in animals. It has facilitated intubation in apneic pigs with a simulated difficult airway.

Objective: To report on the first clinical study to examine the efficacy of using SJV via the WEI JET, in combination with end-tidal CO(2) pressure (PetCO(2)) monitoring during SJV, in maintaining oxygenation during direct laryngoscopy, and in facilitating placement of the WEI JET, and comparing it to the standard intubation technique using a conventional endotracheal tube. The relative safety of using SJV via the WEI JET in airway management was also addressed to provide the foundation for a larger-scale clinical study using the WEI JET, to be carried out in the future.

Methods: Patients in the control group were intubated with a conventional endotracheal tube, and patients in the experimental group were intubated with a WEI JET. The effectiveness of SJV through a WEI JET in maintaining proper oxygenation, and the use of PetCO(2) monitoring to facilitate intubation, were studied and compared to the control group. Complications such as sore throat, laryngospasm, and barotrauma were recorded during the study and 24 h after extubation.

Results: In the WEI JET group, pulse oxygen saturation (SpO(2)) was 100% in all patients during intubation. No serious complications were detected, and the incidence of minor complications was comparable to the control group. Under PetCO(2) guidance, 100% of patients in the WEI JET group were intubated on the first attempt, compared to 30% of Grade III view patients in the control group, who required two attempts.

Conclusion: Using the WEI JET with SJV provides adequate oxygenation during tracheal intubation in apneic patients for a prolonged period of time, with no difference in complications compared to the standard intubation technique. PetCO(2) monitoring facilitated intubation in patients with a Grade III glottis view.