Plate, C.M.A. (Charlotte) (2018) Predictors of failure in supraglottic Superimposed High Frequency Jet Ventilation (SHFJV) during upper airway surgery in adult and paediatric patients. thesis, Medicine.
Full text available on request.Abstract
OBJECTIVE/ During upper airway surgery the anaesthesiologist and the surgeon often encounter problems due to the fact that they must share the airway. To avoid this problem supraglottic Superimposed High Frequency Jet Ventilation (SHFJV) was introduced. The incidence of failure with the use of SHFJV in upper airway surgery is very low, although sometimes hypoxia and hypercapnia occur, requiring ventilation to be converted to conventional intratracheal intubation technique. To our knowledge, the factors that may contribute to the failure of SHFJV has not been described yet. We aimed to identify patient and surgical factors associated to failure of SHFJV in upper airway surgery in both the adult and paediatric patient population. METHODS/ Patients who underwent upper airway surgery in the UMCG while being ventilated with SHFJV from November 2007 until November 2017 were included in this observational, retrospective study. Due to the differences in pathology, treatment and anatomy, patients were divided into an adult group (>17 years) and a paediatric group (0-17 years). Variables including age, BMI, diagnosis, treatment, obstruction of lumen, comorbidities, anatomy of the airway and laser usage were analysed to study their association with failure of SHFJV. RESULTS/ 323 surgeries with SHFJV were observed in 228 patients. In the adult population, 26 (12%) of the 224 surgeries had to be converted from SHFJV to a different manner of ventilation. ‘Higher BMI’ (p=<0.001); ‘Positive history of pulmonary pathology’ (p=<0.001); ‘ASA-Class of 3 or 4’ (p=0.01); and a ‘High percentage of obstruction’ (p=0.011) were univariate factors contributing to conversion. Backward stepwise multivariate regression found ‘High BMI’ and a ‘Positive history of pulmonary pathology’ to be associated with SHFJV failure. In the paediatric population 13 (13%) of the 99 surgeries were converted. ‘High percentage of obstruction’ was the only univariate variable associated with conversion (p=0.04). CONCLUSION/ Adult patients with high BMI and patients with a positive history of pulmonary pathology have higher chance of failure of SHFJV during upper airway surgery. This finding has major clinical importance as it allows for better risk assessment and preparation before surgery. In paediatric patients only ‘high percentage of obstruction’ minimally contributed to the conversion of SHFJV during upper airway surgery. The clinical implications of this finding have to be further evaluated. In general, based on this study, SHFJV can be safely used with upper airway surgery in the majority of the patients.
| Item Type: | Thesis (Thesis) |
|---|---|
| Supervisor name: | Halmos, Dr. GB Department of Otorhinolaryngology and Head an and Krenz, G Department of Anesthesiology |
| Faculty: | Medical Sciences |
| Date Deposited: | 25 Jun 2020 10:48 |
| Last Modified: | 25 Jun 2020 10:48 |
| URI: | https://umcg.studenttheses.ub.rug.nl/id/eprint/901 |
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