An urgent technique of applying high frequency jet ventilation in patients with extreme periglottic stenosis

Applying high frequency jet ventilation (HFJV) to patients with extreme periglottic stenosis (EPS) carries high risk of barotrauma or severe circulatory depression, since the stenotic airway will result in inadequate outflow tract obstructing the passage of the expired gas. We encountered with emergent obstruction of the outflow tract in 13 patients with EPS during HFJV in endolaryngeal microsurgery (ELM) procedures. The phenomenon of progressive gas trapping occurred within seconds in all patients. Barotrauma and disastrous circulatory depression would occur if we had not recognized them and then taken some measures immediately. We surmounted these potentially lethal events without interrupting the surgical procedures and found neither hypoxia nor barotrauma in all these patients. This may attribute to an urgent technique, i.e., intermittent disconnecting the jet conduit at the junction of the proximal end of the insufflation catheter and the distal end of the patient connecting tube of jet ventilator during HFJV.