To evaluate the effect of two ventilatory strategies (conventional bag-mask ventilation vs. manual jet ventilation) on peak inspiratory pressures and dynamic compliance using electrical impedance tomography in adult patients undergoing interventional rigid bronchoscopy for central airway obstruction under total intravenous anaesthesia - A pilot randomised controlled study: VENTIJET-EIT study.

Abstract

Background and aims: Interventional rigid bronchoscopy (IRB) for central airway obstruction (CAO) may lead to significant changes in airway pressures and compliance. The objectives of this study were to evaluate the effect of conventional bag-mask ventilation versus manual jet ventilation on peak inspiratory pressures (PIPs) and dynamic compliance measured by electrical impedance tomography (EIT) during IRB for CAO.

Methods: This pilot randomised controlled study included 60 patients in two groups: Group BMV (conventional bag-mask ventilation performed with manual coordination of self-inflating bag pressure and careful observation of chest expansion) and Group JET (manual jet ventilation with Sander's adapter under total intravenous anaesthesia). PIP and dynamic compliance were measured pre- and post-IRB using EIT with the insertion of an I-gel airway device.

Results: The mean PIP pre- and post-IRB with Group BMV was found to be significantly lower, that is, 24.13 [standard deviation (SD): 8.33] versus 21.56 (SD: 6.71) (P = 0.02), whereas it was comparable in Group JET (P > 0.05). The median dynamic compliance in Group JET post-IRB was significantly higher, that is, 55 [range: 42-73, interquartile range (IQR): 51-58], compared to 49 (31-67, 43-53) in Group BMV (P = 0.002). The regional distribution of ventilation was comparable at all time points across both groups (P > 0.05).

Conclusion: Conventional bag-mask ventilation and jet ventilation provide comparable outcomes in terms of PIP, dynamic compliance and regional distribution of ventilation in patients undergoing IRB for CAO.