Regional lung ventilation during supraglottic and subglottic jet ventilation: A randomized cross-over trial

Area of Science:

• Anesthesiology
• Respiratory Physiology
• Surgical Ventilation

Background:

• Supraglottic and subglottic jet ventilation are utilized in laryngotracheal surgery.
• Supraglottic ventilation is hypothesized to offer superior ventilation and atelectasis prevention.

Purpose of the Study:

• To evaluate if supraglottic ventilation leads to more posterior ventilation distribution, indicating better dependent-lung ventilation.
• To assess if supraglottic ventilation enhances oxygenation and carbon dioxide elimination.

Main Methods:

• A randomized, cross-over trial was conducted in an operating room setting.
• Thirty patients undergoing elective micro-laryngotracheal surgery were included.
• Regional ventilation was assessed using electrical impedance tomography, alongside arterial blood gas analysis.

Main Results:

• No significant difference was found in the center of ventilation between supraglottic and subglottic jet ventilation.
• Supraglottic ventilation showed slightly increased ventromedial and decreased dorsal lung ventilation.
• Arterial oxygenation was significantly worse with supraglottic ventilation, while carbon dioxide elimination was similar, with a slight advantage for supraglottic.

Conclusions:

• The center of ventilation distribution was comparable between supraglottic and subglottic jet ventilation.
• Subglottic jet ventilation improved dorsal-dependent lung ventilation and provided superior arterial oxygenation.
• Both techniques achieved effective carbon dioxide elimination.