Comparison of the Effects of High-Flow Nasal Cannula Oxygen and Jet Ventilation Techniques.

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).