The Laryngoscope · 2026
Comparison of the Effects of High-Flow Nasal Cannula Oxygen and Jet Ventilation Techniques.
СтатьяНазвание и аннотация: Перевод пока не подготовлен
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Özdağlı Seda, Canbaz Mert, Çamcı Emre, Kırşan Nil, Akdoğan Basri, Altun Dilek, Çelik Mehmet, Altun Demet
Аннотация
OBJECTIVES: Shared airway management in endolaryngeal surgery conflicts surgical access with adequate ventilation. This study compared the effects of High-Frequency Jet Ventilation (HFJV) and Transnasal Humidified Rapid-Insufflation Ventilatory Exchange (THRIVE) via High-Flow Nasal Cannula (HFNC) on perioperative oxygenation, arterial CO2 kinetics, and metabolic stability.
METHODS: In this prospective randomized controlled study, 36 patients (ASA I-II) undergoing elective endolaryngeal procedures were randomized into HFJV (n = 18) or HFNC (n = 18) groups. Both cohorts received standardized TIVA and neuromuscular blockade. Primary outcomes were longitudinal PaCO2 changes at five intervals: baseline (T0), 10 (T1), 20 (T2), 30 (T3) minutes post-induction, and at surgical conclusion (T4). Secondary outcomes included PaO2, pH, and lactate.
RESULTS: PaCO2 levels were comparable at T0 and T1. At 20 min (T2), PaCO2 was significantly higher in the HFNC group (55.5 vs. 44.5 mmHg; p = 0.002). At surgical conclusion (T4), median PaCO2 reached 66.5 mmHg in the HFNC group versus 44.5 mmHg in the HFJV group (p < 0.001). Consequently, the HFNC group exhibited significantly lower pH (7.21 vs. 7.31; p < 0.001) and elevated lactate (3.4 vs. 2.5 mmol/L; p < 0.001) at T4. PaO2 levels at T3 and T4 were significantly superior in the HFJV group (p < 0.001).
CONCLUSION: While HFNC offers an ideal tubeless field for short interventions, its use is limited by time-dependent hypercapnia and progressive respiratory acidosis. We propose a clinical "20-min threshold" for HFNC; for longer endolaryngeal procedures, HFJV is preferred to maintain ventilatory and metabolic homeostasis.
TRIAL REGISTRATION: This clinical trial was registered at ClinicalTrials.gov (registration number NCT05746949).
METHODS: In this prospective randomized controlled study, 36 patients (ASA I-II) undergoing elective endolaryngeal procedures were randomized into HFJV (n = 18) or HFNC (n = 18) groups. Both cohorts received standardized TIVA and neuromuscular blockade. Primary outcomes were longitudinal PaCO2 changes at five intervals: baseline (T0), 10 (T1), 20 (T2), 30 (T3) minutes post-induction, and at surgical conclusion (T4). Secondary outcomes included PaO2, pH, and lactate.
RESULTS: PaCO2 levels were comparable at T0 and T1. At 20 min (T2), PaCO2 was significantly higher in the HFNC group (55.5 vs. 44.5 mmHg; p = 0.002). At surgical conclusion (T4), median PaCO2 reached 66.5 mmHg in the HFNC group versus 44.5 mmHg in the HFJV group (p < 0.001). Consequently, the HFNC group exhibited significantly lower pH (7.21 vs. 7.31; p < 0.001) and elevated lactate (3.4 vs. 2.5 mmol/L; p < 0.001) at T4. PaO2 levels at T3 and T4 were significantly superior in the HFJV group (p < 0.001).
CONCLUSION: While HFNC offers an ideal tubeless field for short interventions, its use is limited by time-dependent hypercapnia and progressive respiratory acidosis. We propose a clinical "20-min threshold" for HFNC; for longer endolaryngeal procedures, HFJV is preferred to maintain ventilatory and metabolic homeostasis.
TRIAL REGISTRATION: This clinical trial was registered at ClinicalTrials.gov (registration number NCT05746949).