Percutaneous transtracheal jet ventilation in head and neck surgery

Objective: To assess the safety and efficacy of percutaneous transtracheal jet ventilation (PTJV) in the management of the difficult airway. Design: Retrospective case series. Setting: Academic, tertiary care medical center Patients: Forty-three consecutive PTJV procedures performed on 33 patients with anticipated airway difficulty undergoing direct laryngoscopy for diagnosis and/or treatment of head and neck cancer (91%) or benign lesions. Main Outcome Measures: Duration of PTJV, oxygen saturation values by pulse oximetry, and incidence of tracheotomy and complications. Results: The mean duration of PTJV was 43 minutes, and mean minimum oxygen saturation was 97%. Biopsy was performed in 27 (62%) of the cases, and a laser excision in 12 (28%). Seven tracheotomies were planned preoperatively, and 2 were performed intraoperatively. Two additional patients required tracheotomies in the immediate postoperative period. Two (5%) complications occurred: I pneumothorax that resolved with chest tube insertion and 1 kinked catheter resulting, in soft tissue emphysema that resolved spontaneously. Conclusions: Percutaneous transtracheal jet ventilation is a safe and effective method of ventilation in patients with anticipated airway difficulty. It is particularly useful in patients who are not in immediate airway distress preoperatively but who may be difficult or impossible to intubate after induction of general anesthesia. Percutaneous transtracheal jet ventilation may help to avoid tracheotomy in this setting and should be routinely available as an option for airway, management in patients with head and neck cancer.