BJA Advance Access originally published online on March 30, 2006
British Journal of Anaesthesia 2006 96(5):650-659; doi:10.1093/bja/ael074
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Superimposed high-frequency jet ventilation (SHFJV) for endoscopic laryngotracheal surgery in more than 1500 patients
1 Department of Anaesthesia and General Intensive Care (A), Vienna General Hospital, Medical University of Vienna Waehringer Guertel 18-20, A-1090 Vienna, Austria
2 Department of Otorhinolaryngology, Head and Neck Surgery, Vienna General Hospital, Medical University of Vienna Waehringer Guertel 18-20, A-1090 Vienna, Austria
*Corresponding author. E-mail: dr.rezaie{at}gmx.net
Background. Superimposed high-frequency jet ventilation (SHFJV), which does not require any tracheal tubes or catheters, was developed specifically for use in laryngotracheal surgery. SHFJV uses two jet streams with different frequencies simultaneously and is applied in the supraglottic space using a jet laryngoscope and jet ventilator.
Methods. Between 1990 and 2004, SHFJV was studied in 1515 consecutive patients (including 158 children requiring laryngotracheal surgery) prospectively. Ventilation was performed with an air/oxygen mixture and anaesthesia was administered i.v.
Results. Adequate oxygenation and ventilation was achieved in 1512 patients. Arterial blood gas analyses (BGA) were performed between 1990 and 1994; thereafter BGA was only performed in patients with high-grade stenosis of the larynx/trachea or high-risk patients [n=623, mean 
133.8 (39.4) mm Hg and mean 
42.3 (10.1) mm Hg]. There were no significant changes in or during the entire period of SHFJV. No complications secondary to the ventilation technique were observed; in particular, no barotrauma occurred. Three patients required tracheal intubation. SHFJV was also successfully used for laser surgery (n=312). It proved to be a safe mode of ventilation without any complications such as airway fire, major haemorrhage, or aspiration of debris.
Conclusion. SHFJV is an advanced ventilation mode playing a pivotal role in the (open) ventilatory support/ventilation of patients with laryngotracheal stenosis. It is particularly indicated in cases of severe stenosis and offers optimal conditions for laryngotracheal surgery, including laser surgery and stent implantation techniques.
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