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

IF 5 2区医学 Q1 ANESTHESIOLOGY

Journal of Clinical Anesthesia Pub Date : 2025-02-10 DOI:10.1016/j.jclinane.2025.111773

Marita Windpassinger MD , Michal Prusak MD , Jana Gemeiner MD , Maximilian Edlinger-Stanger MD , Imme Roesner MD , Doris-Maria Denk-Linnert MD , Olga Plattner MD , Ahmed Khattab MSc , Eugenijus Kaniusas Dr. DI , Lu Wang MS , Daniel I. Sessler MD

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Abstract

Objective

Test the hypothesis that the center of ventilation, a measure of ventro-dorsal atelectasis, is posterior during supraglottic ventilation indicating better dependent-lung ventilation. Secondarily, we tested the hypothesis that supraglottic ventilation improves oxygenation and carbon dioxide elimination.

Background

Supraglottic and subglottic jet ventilation are both used during laryngotracheal surgery. Supraglottic jet ventilation may better prevent atelectasis and provide superior ventilation.

Design

Randomized, cross-over trial.

Setting

Operating rooms.

Patients

Patients having elective micro-laryngotracheal surgery.

Interventions

Patients were sequentially ventilated for 5 min with one randomly selected type of jet ventilation before being switched to the alternative method.

Measurements

Regional ventilation distribution was estimated using electrical impedance tomography, with arterial oxygenation and carbon dioxide partial pressures being simultaneously evaluated.

Results

Thirty patients completed the study. There were no statistically significant or clinically meaningful differences in the center of ventilation with supraglottic and subglottic ventilation. However, ventilation with the supraglottic approach was about 4 % higher in the ventromedial lung region and about 4 % lower in the dorsal lung. Surprisingly, arterial blood oxygenation was considerably worse with supraglottic (173 [156, 199] mmHg) than subglottic ventilation (293 [244, 340] mmHg). Arterial carbon dioxide partial pressure was near 40 mmHg with each approach, although slightly lower with supraglottic jet ventilation.

Conclusion

The center of ventilation distribution, a measure of atelectasis, was similar with supraglottic and subglottic jet ventilation. Subglottic jet ventilation improved the dorsal-dependent lung region and provided superior arterial oxygenation. Both techniques effectively eliminated carbon dioxide, with the supraglottic approach demonstrating slightly superior efficacy.

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声门上和声门下喷射通气时区域肺通气：一项随机交叉试验

目的验证声门上通气时通气中心（腹背张不张的测量指标）位于后部的假说，该假说表明依赖肺通气效果较好。其次，我们验证了声门上通气改善氧合和二氧化碳消除的假设。背景声门上和声门下喷射通气在喉气管手术中都有应用。声门上喷射通气能更好地预防肺不张，提供良好的通气。设计随机、交叉试验。SettingOperating房间。患者择期微创喉气管手术患者。干预措施：患者随机选择一种喷射通气方式，连续通气5分钟，然后切换到另一种方法。测量使用电阻抗断层扫描估计区域通风分布，同时评估动脉氧合和二氧化碳分压。结果30例患者完成了研究。声门上通气与声门下通气的通气中心差异无统计学意义或临床意义。然而，声门上入路通气在肺腹内侧区域高约4%，在肺背侧低约4%。令人惊讶的是，声门上通气（173 [156,199]mmHg）比声门下通气（293 [244,340]mmHg）的动脉血氧合差得多。每次入路动脉二氧化碳分压均接近40 mmHg，声门上喷射通气略低。结论通气中心分布与声门上、声门下喷流通气相似，是衡量肺不张的指标。声门下喷射通气改善了背侧依赖的肺区，并提供了优越的动脉氧合。两种技术都能有效地消除二氧化碳，声门上入路的效果略好。

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来源期刊

Journal of Clinical Anesthesia 医学-麻醉学

CiteScore

7.40

自引率

4.50%

发文量

346

审稿时长

23 days

期刊介绍： The Journal of Clinical Anesthesia (JCA) addresses all aspects of anesthesia practice, including anesthetic administration, pharmacokinetics, preoperative and postoperative considerations, coexisting disease and other complicating factors, cost issues, and similar concerns anesthesiologists contend with daily. Exceptionally high standards of presentation and accuracy are maintained. The core of the journal is original contributions on subjects relevant to clinical practice, and rigorously peer-reviewed. Highly respected international experts have joined together to form the Editorial Board, sharing their years of experience and clinical expertise. Specialized section editors cover the various subspecialties within the field. To keep your practical clinical skills current, the journal bridges the gap between the laboratory and the clinical practice of anesthesiology and critical care to clarify how new insights can improve daily practice.