Jet ventilation (JV) is a specialized technique frequently employed during surgeries involving the airway. In anesthesiology, maintaining effective ventilation is critical for patient safety during procedures. By providing high-velocity bursts of oxygen into the airway, JV ensures that patients are breathing enough oxygen even while undergoing intensive surgeries under anesthesia where standard oxygenation and ventilation practices do not work. The technique enables anesthesiologists to precisely control ventilation. It offers a unique solution during procedures where space in the airway is limited, which is an important constraint when both surgeons and anesthesiologists require access to the airway. In comparison to conventional ventilation, JV only involves the placement of a small-bore catheter which takes up very little space in the airway and therefore increases visibility (1) in the surgical field during maxillofacial and laryngotracheal surgeries, for example (2).
Depending on the patient and the procedure, jet ventilation can be employed in a few different varieties to meet surgical needs. High-Frequency Jet Ventilation (HFJV) is used in anesthesiology to deliver high frequency, low volume breaths. This technique is advantageous as it minimizes lung movement and airway interference while keeping the peak pressure in the airways low (3). HFJV delivers between 240 to 660 breaths per minute (4). Some challenges exist with the use of HFJV, including ensuring that enough carbon dioxide is exhaled with each breath. As a result, to ensure that ventilation is working adequately, intermittent blood gas analysis must be performed (5).
Superimposed High-Frequency Jet Ventilation (SHFJV) differs from HFJV in that it does not require any tracheal tubes or catheters (6). Developed specifically for its use in laryngotracheal surgery, it “uses two jet streams with different frequencies simultaneously and is applied in the supraglottic space using a jet laryngoscope and jet ventilator (6).” In contrast to HFJV, it is shown to be more effective in the removal of carbon dioxide (2). SHFJV is also considered a safe technique for use in patients at a high risk of pulmonary or cardiac diseases (7).
Despite its many benefits, jet ventilation also presents challenges in anesthesiology. The method runs the risk of encountering technical problems, such as the disconnecting or kinking of the jet catheter, which if not quickly resolved could lead to asphyxiation. As previously mentioned, jet ventilation may increase risk for retaining too much carbon dioxide, which could also lead to asphyxiation. Additionally, if the gasses being administered to the patient are not adequately humidified at the correct temperature, this could lead to increased bronchial secretions and can even cause hypothermia (8).
These challenges reinforce the important role anesthesiologists play in monitoring the breathing of patients during surgeries. In keeping a close eye on the circulatory, respiratory, renal, central nervous, and neuromuscular systems, anesthesiologists strive to avoid these complications and maintain patient safety during the use of jet ventilation (9).
In anesthesiology, jet ventilation provides an important alternative to conventional ventilation methods, particularly during surgeries that require access to the airway. Its ability to deliver small, rapid bursts of gas makes it invaluable in complex airway management scenarios. While highly effective, the technique requires precise control and vigilant monitoring by anesthesiologists to ensure patient safety and optimal outcomes.
References
1. Dow, Olivia, Elizabeth Whatling, and Bhavesh Patel. “Jet Ventilation for Maxillofacial and Laryngotracheal Anaesthesia: A Narrative Review.” Journal of Oral and Maxillofacial Anesthesia 3, no. 1. March 1, 2024: 4. https://doi.org/10.21037/joma-23-24.
2. Galmén, Karolina, Piotr Harbut, Jacob Freedman, and Jan G. Jakobsson. “The Use of High-Frequency Ventilation during General Anaesthesia: An Update.” F1000Research 6. May 30, 2017: 756. https://doi.org/10.12688/f1000research.10823.1.
3. Musil, Peter, Stefan Harsanyi, Pavol Torok, Monika Paulikova, Didier Moens, Ladislav Kalas, and Peter Kalas. “Application and Technical Principles of Catheter High-Frequency Jet Ventilation.” Advances in Respiratory Medicine 91, no. 4. June 27, 2023: 278–87. https://doi.org/10.3390/arm91040022.
4. Ethawi, Yahya H, Ayman Abou Mehrem, John Minski, Chelsea A Ruth, and Peter G Davis. “High Frequency Jet Ventilation versus High Frequency Oscillatory Ventilation for Pulmonary Dysfunction in Preterm Infants.” Cochrane Library 2016, no. 5. May 6, 2016. https://doi.org/10.1002/14651858.cd010548.pub2.
5. Jiang, Yandong, and Robert M. Kacmarek. “Efficacy of Superimposed High-Frequency Jet Ventilation Applied to Variable Degrees of Tracheal Stenosis.” Anesthesiology 123, no. 4. August 8, 2015: 747–49. https://doi.org/10.1097/aln.0000000000000819.
6. Rezaie-Majd, A., W. Bigenzahn, D.-m. Denk, M. Burian, J. Kornfehl, M.Ch. Grasl, G. Ihra, and A. Aloy. “Superimposed High-Frequency Jet Ventilation (SHFJV) for Endoscopic Laryngotracheal Surgery in More than 1500 Patients.” British Journal of Anaesthesia 96, no. 5 (March 31, 2006): 650–59. https://doi.org/10.1093/bja/ael074.
7. Lanzenberger-Schragl, E, A Donner, M C Grasl, M Zimpfer, and A Aloy. “Superimposed High-Frequency Jet Ventilation for Laryngeal and Tracheal Surgery.” Archives of Otolaryngology – Head and Neck Surgery 126, no. 1. January 1, 2000: 40. https://doi.org/10.1001/archotol.126.1.40.
8. Berré, J., A. M. Ros, J. L. Vincent, P. Dufaye, S. Brimioulle, and R. J. Kahn. “Technical and Psychological Complications of High-Frequency Jet Ventilation.” Intensive Care Medicine 13, no. 2. March 1, 1987: 96–99. https://doi.org/10.1007/bf00254792.
9. Anderson, Jay A. “Respiratory Monitoring for Anesthesia and Sedation.” Anesthesia Progress 70, no. 4. January 1, 2023: 198–201. https://doi.org/10.2344/862700.
