Flow-controlled ventilation during ear, nose and throat surgery: A prospective observational study

Area of Science:

• Anesthesiology
• Respiratory Medicine
• Critical Care

Background:

• Flow-controlled ventilation (FCV) is an emerging mechanical ventilation mode using constant airflow during inspiration and expiration.
• FCV integrates automatic airway flow control, intratracheal pressure monitoring, and pressure regulation.
• This represents the first clinical study describing FCV in practice.

Purpose of the Study:

• To conduct an initial clinical assessment of FCV in mechanically ventilated patients.
• To evaluate the potential utility of FCV for peri-operative use.
• To explore FCV in the context of ear, nose, and throat (ENT) surgery.

Main Methods:

• Observational study conducted at two German academic medical centers.
• Included adult patients undergoing elective ENT surgery, excluding specific high-risk conditions.
• Utilized a new ventilator (Evone) delivering FCV via a narrow-bore endotracheal tube (Tritube).

Main Results:

• Fifteen evaluable datasets were obtained from 16 patients.
• Achieved target end-tidal CO2 (PetCO2) levels with normal minute volume and intratidal tracheal pressure amplitude (Δp).
• Reported five adverse events: one tube obstruction and four tube dislocations.

Conclusions:

• FCV demonstrated adequate PetCO2, minute volume, and Δp in the studied patient group.
• High flow resistance of the Tritube may contribute to tube dislocations, particularly with coughing.
• FCV presents a promising new option for short-term mechanical ventilation and airway management.