Advertisement

Internal and Emergency Medicine

, Volume 12, Issue 5, pp 667–673 | Cite as

Supraglottic jet oxygenation and ventilation-assisted fibre-optic bronchoscope intubation in patients with difficult airways

  • Caineng Wu
  • Jianqi Wei
  • Qingyun Cen
  • Xuefan Sha
  • Qingxiang Cai
  • Wuhua MaEmail author
  • Ying CaoEmail author
EM - AIRWAY FORUM

Abstract

A difficult airway may lead to hypoxia and brain damage. The WEI Nasal Jet Tube (WNJ) is a new nasal pharyngeal tube that applies supraglottic jet oxygenation and ventilation (SJOV) for patients during tracheal intubation without the need for mask ventilation. We evaluated the effectiveness and safety of SJOV-assisted fibre-optic bronchoscopy (FOB) using the WNJ in the management of difficult tracheal intubations. A total of 50 adult patients with Cormack–Lehane grade ≥3 and general anesthesia with tracheal intubation were randomly assigned to either the laryngeal mask airway (LMA) or WNJ groups. The primary outcome was the percentage of patients with SpO2 values lower than 94 % during intubation. The proportion of successful intubations, total time of intubation, and associated complications were also recorded. The percentage of patients with SpO2 values lower than 94 % during intubation was significantly higher in the LMA group (25 % in the LMA vs. 0 % in the WNJ, P = 0.01). Although there were no statistically significant differences in the total success rates of intubation, the first-attempt success rate was significantly higher in the WNJ group (100 vs. 79.2 %, P = 0.02). The total time required for intubation with the WNJ was shorter than that of the LMA (73.4 vs. 99.5 s, P < 0.001), although the duration of fibre-optic intubation was similar. The incidence of complications was similar between the two groups. SJOV-assisted FOB using the WNJ improved oxygenation and successful tracheal intubation in the management of difficult airways. This technique can be used as an alternative approach to improve success and minimize hypoxia during difficult airway management.

Keywords

Supraglottic jet oxygenation and ventilation Fibre-optic bronchoscope Difficult airway Laryngeal mask airway 

Notes

Acknowledgments

We appreciate the editing of the manuscript by Huafeng Wei from the University of Pennsylvania. This study was supported by the Department of Anesthesia of the First Affiliated Hospital of Guangzhou University of Chinese Medicine.

Compliance with ethical standards

Conflict of interest

Dr. Huafeng Wei provided the WNJ and assisted in the editing of the manuscript. Dr. Huafeng Wei is the inventor of the WEI Nasal Jet Tube (WEI NASAL JET or WNJ) and holds multiple patent applications.

Statement of human and animal rights

All procedures performed in our studies involving human participants were in accordance with ethical standards of the 1964 Helsinki declaration and its later amendments.

Informed consent

Informed consent was obtained from all participants included in the study.

Funding

This study was supported by the Department of Anesthesia of the First Affiliated Hospital of Guangzhou University of Chinese Medicine.

References

  1. 1.
    Cook TM, Woodall N, Frerk C et al (2011) Major complication of airway management in the UK: results of the fourth national audit project of the royal college of anaesthetists and the difficult airway society. Part 1: anaesthesia. Br J Anaesth 106:617–631CrossRefPubMedGoogle Scholar
  2. 2.
    Wong DT, Wang J, Venkatraghavan L (2012) Awake bronchoscopic intubation through an air-Q® with the application of BIPAP. Can J Anesth 59:915–916CrossRefPubMedGoogle Scholar
  3. 3.
    Roesenstock CV, Thogersen B, Afshari A et al (2012) Awake fiberoptic or awake video laryngoscopic tracheal intubation in patients with anticipated difficult airway management: a randomized clinical trial. Anesthesiology 116:1210–1216CrossRefGoogle Scholar
  4. 4.
    Liu HH, Zhou T, Wei JQ et al (2015) Comparison between remifentanil and dexmedetomidine for sedation during modified awake fiberoptic intubation. Exp Ther Med 9:1259–1264PubMedPubMedCentralGoogle Scholar
  5. 5.
    Apfelbaum JL, Hagberg CA, Caplan RA et al (2013) Practice guidelines for management of the difficult airway: an updated report by the American society of anesthesiologists task force on management of the difficult airway. Anesthesiology 118:251–270CrossRefPubMedGoogle Scholar
  6. 6.
    Frerk C, Mitchell VS, McNarry AF, Difficult Airway Society intubation guidelines working group et al (2015) Difficult airway society 2015 guidelines for management of unanticipated difficult intubation in adults. Br J Anaesth 115:827–848CrossRefPubMedPubMedCentralGoogle Scholar
  7. 7.
    American Society of Anesthesiologists TaskForce on Management of the Difficult Airway (2003) Practice guidelines for management of the difficult airway: an updated report by the American society of anesthesiologists task force on management of the difficult airway. Anesthesiology 98:1269–1277CrossRefGoogle Scholar
  8. 8.
    Peng J, Ye J, Zhao Y et al (2012) Supraglottic jet ventilation in difficult airway management. J Emerg Med 43:382–390CrossRefPubMedGoogle Scholar
  9. 9.
    Levitt C, Wei H (2014) Supraglotic pulsatile jet oxygenation and ventilation during deep propofol sedation for upper gastrointestinal endoscopy in a morbidly obese patient. J Clin Anesth 26:157–159CrossRefPubMedGoogle Scholar
  10. 10.
    Wei HF (2006) A new tracheal tube and methods to facilitate ventilationand placement in emergency airway management. Resuscitation 70:438–444CrossRefPubMedGoogle Scholar
  11. 11.
    Wu CN, Ma WH, Wei JQ et al (2015) Laryngoscope and a new tracheal tube assist lightwand intubation in difficult airways due to unstable cervical spine. PLoS One 10:e0120231CrossRefPubMedPubMedCentralGoogle Scholar
  12. 12.
    Berkow LC, Schwartz JM, Kan K et al (2011) Use of the Laryngeal Mask Airway-Aintree Intubating Catheter-fiberoptic bronchoscope technique for difficult intubation. J Clin Anesth 23:534–539CrossRefPubMedGoogle Scholar
  13. 13.
    Van Zundert TC, Wong DT, Van Zundert AA (2013) The LMA-supreme™ as an intubation conduit in patients with known difficult airways: a prospective evaluation study. Acta Anaesthesiol Scand 57:77–81CrossRefPubMedGoogle Scholar
  14. 14.
    Dziewit JA, Wei H (2011) Supraglottic jet ventilation assists intubation in a Marfan’s syndrome patient with a difficult airway. J Clin Anesth 23:407–409CrossRefPubMedGoogle Scholar
  15. 15.
    Weiss M, Gerber AC, Schmitz A (2004) Continuous ventilation technique for laryngeal mask airway (LMA™) removal after lation technique for laryngealma. Pediatr Anesth 14:936–940CrossRefGoogle Scholar
  16. 16.
    Abdellatif AA, Ali MA (2014) GlideScope videolaryngoscope versus flexible fiberoptic bronchoscope for awake intubation of morbidly obese patient with predicted difficult intubation. Middle East J Anesthesiol 22:385–392PubMedGoogle Scholar
  17. 17.
    Johnson DM, From AM, Smith RB et al (2005) Endoscopic study of mechanisms of failure of endotracheal tube advancement into the trachea during awake fiberoptic orotracheal intubation. Anesthesiology 102:910–914CrossRefPubMedGoogle Scholar
  18. 18.
    Collins SR, Blank RS (2014) Fiberoptic intubation: an overview and update. Respir Care 59:865–878CrossRefPubMedGoogle Scholar
  19. 19.
    Boyce JR, Waite PD, Louis PJ et al (2003) Transnasal jet ventilation is a useful adjunct to teach fibreoptic intubation: a preliminary report. Can J Anaesth 50:1056–1060CrossRefPubMedGoogle Scholar
  20. 20.
    Dziewit JA, Wei H (2011) Supraglottic jet ventilation assists intubation in a Marfan’s syndrome patient with a difficult airway. J Anesth Clin Res 23:407–409CrossRefGoogle Scholar
  21. 21.
    Ihra G, Gockner G, Kashanipour A et al (2000) High-frequency jet ventilation in European and North American institutions: developments and clinical practice. Eur J Anaesthesiol 17:418–430CrossRefPubMedGoogle Scholar
  22. 22.
    Benumof JL, Scheller MS (1989) The importance of transtracheal jet ventilation in the management of the difficult airway. Anesthesiology 1:769–778CrossRefGoogle Scholar
  23. 23.
    Craft TM, Chambers PH, Ward ME et al (1990) Two cases of barotrauma associated with transtracheal jet ventilation. Br J Anaesth 64:524–527CrossRefPubMedGoogle Scholar

Copyright information

© SIMI 2016

Authors and Affiliations

  1. 1.Department of AnesthesiaThe First Affiliated Hospital of Guangzhou University of Chinese MedicineGuangzhouChina
  2. 2.School of Pharmaceutical SciencesSouthern Medical UniversityGuangzhouChina

Personalised recommendations