Seven years of Transtracheal Jet Ventilation: Lessons Learnt.

Background: Management of the difficult airway in ENT surgery can be challenging, particularly because conventional difficult airway algorithms often are not applicable. Awake tracheostomies are now less frequently performed by surgeons, and in some cases may not be feasible due to the location and spread of pathology. Transtracheal jet ventilation (TTJV) offers a safe, feasible alternative that can be performed with minimal discomfort on the awake patient, yet is rarely practiced in Australian healthcare centers due to lack of familiarity.1 To our knowledge, no audit has been performed on TTJV in Australia on this scale for ENT surgery. Method(s): We report a retrospective audit of the use of TTJV in a tertiary healthcare centre in Melbourne, Victoria, over the past 7 years, with a total of 50 patients with severe airway compromise undergoing pharynolar-yngeal surgery. Result(s): TTJV was successful in 98% of patients. Only one patient required further postoperative attention for possible airway compromise, but recovered uneventfully. Minor complications occurred in 12% of patients, which is a substantial improvement compared to other cases in the literature. Rates of complications and ease of insertion (measured by number of needle passes) demonstrated improvement. Conclusion(s): TTJV should always be performed using a high-frequency jet ventilator (HFJV). Imaging prior to TTJV is highly recommended. Cannulation of the trachea below the cricothyroid membrane is feasible but more challenging to the inexperienced anaesthetist. Apnoeic oxygenation through the TTJV cannula is delays desaturation in the well-preoxygenated patient.