Eur Arch Otorhinolaryngol DOI 10.1007/s00405-014-2999-1
Letter to the Editor
Ventilation in patients with a tracheal tumor Frederik G. Dikkers · Grita Krenz · Dirk‑Jan Slebos · G. Boukes Eindhoven
Received: 24 February 2014 / Accepted: 3 March 2014 © Springer-Verlag Berlin Heidelberg 2014
Sir, We have read with great interest the recent article: “Clinical manifestation and management of primary malignant tumors of the cervical trachea” by Li et al. [1]. The authors describe an impressive series of 31 patients treated over a period of 15 years. Treatment is described extensively, paving a way for discussion. Diagnostic endoscopic examination is described as being a challenging technique to carry out. The ventilation techniques employed in resection were (sometimes emergent) endotracheal intubation, laryngeal mask airway, or tracheotomy. One case underwent sternotomy, with tube insertion distal to the tumor. Four cases had a nasotracheal tube postoperatively, and thirteen cases had a “tracheal catheter” inserted for 2–3 weeks. We are in agreement with the authors on two salient points: that tracheotomy under local anesthesia should not be considered as the first choice of treatment; that passing an endotracheal tube through the tumor should be avoided.
In our clinic, we use conventional high frequency jet ventilation (HFJV) with a catheter, and supraglottic high frequency jet ventilation (SHFJV) with the Twin Stream™ multimode respirator (Carl Reiner GMBH, Vienna, Austria). In the case of SHFJV, jet-adapted laryngoscopes are employed. These devices are useful in patients with severe to extreme airway obstruction, both in acute circumstances, and during elective resection and reconstruction (Figs. 1, 2, 3). HFJV and SHFJV are mechanical ventilation modes where air is transported into the patient in an open system. The tidal volumes employed are very small: smaller than the dead space. The induced low pressure behind the tip of the catheter—or the outlet of the nozzle in the laryngoscope—entrains surrounding air, which ventilates the patient. HFJV and SHFJV have several major advantages. SHFJV has an even better visualization and instrumental presentation than HFJV, as the catheter used in HFJV might impede visualization of the larynx. SHFJV is especially
F. G. Dikkers (*) Department of Otorhinolaryngology, University Medical Center Groningen, University of Groningen, P.O. box 30.001, 9700 RB Groningen, The Netherlands e-mail: [email protected] G. Krenz · G. B. Eindhoven Departement of Anaesthesiology, University Medical Center Groningen, University of Groningen, P.O. box 30.001, 9700 RB Groningen, The Netherlands D.-J. Slebos Department of Pulmonology, University Medical Center Groningen, University of Groningen, P.O. box 30.001, 9700 RB Groningen, The Netherlands
Fig. 1 Emergency diagnostic and therapeutic procedure using SHFJV in 51-year-old male with subglottic benign polyp, obstructing the airway in cricoid
13
Eur Arch Otorhinolaryngol
helpful during laser procedures of the larynx and trachea. Experience and vigilance of both the surgical and anesthesia team are paramount for safe procedures. Conflict of interest The authors have no conflicts of interest.
Reference 1. Li Y, Peng A, Yang X, Xiao Z, Wu W, Wang Q (2014) Clinical manifestation and management of primary malignant tumors of the cervical trachea. Eur Arch Otorhinolaryngol 271(2):225–235. doi:10.1007/s00405-013-2429-9
Fig. 2 Emergency diagnostic procedure using SHFJV in 69-year-old male with neuro-endocrine carcinoma, 7 cm from glottis
Fig. 3 Elective procedure using SHFJV in 13-month-old patient with Down syndrome, with post-intubation distal tracheal stenosis. The cryo-probe used here has a circumference of
Letter to the Editor
Ventilation in patients with a tracheal tumor Frederik G. Dikkers · Grita Krenz · Dirk‑Jan Slebos · G. Boukes Eindhoven
Received: 24 February 2014 / Accepted: 3 March 2014 © Springer-Verlag Berlin Heidelberg 2014
Sir, We have read with great interest the recent article: “Clinical manifestation and management of primary malignant tumors of the cervical trachea” by Li et al. [1]. The authors describe an impressive series of 31 patients treated over a period of 15 years. Treatment is described extensively, paving a way for discussion. Diagnostic endoscopic examination is described as being a challenging technique to carry out. The ventilation techniques employed in resection were (sometimes emergent) endotracheal intubation, laryngeal mask airway, or tracheotomy. One case underwent sternotomy, with tube insertion distal to the tumor. Four cases had a nasotracheal tube postoperatively, and thirteen cases had a “tracheal catheter” inserted for 2–3 weeks. We are in agreement with the authors on two salient points: that tracheotomy under local anesthesia should not be considered as the first choice of treatment; that passing an endotracheal tube through the tumor should be avoided.
In our clinic, we use conventional high frequency jet ventilation (HFJV) with a catheter, and supraglottic high frequency jet ventilation (SHFJV) with the Twin Stream™ multimode respirator (Carl Reiner GMBH, Vienna, Austria). In the case of SHFJV, jet-adapted laryngoscopes are employed. These devices are useful in patients with severe to extreme airway obstruction, both in acute circumstances, and during elective resection and reconstruction (Figs. 1, 2, 3). HFJV and SHFJV are mechanical ventilation modes where air is transported into the patient in an open system. The tidal volumes employed are very small: smaller than the dead space. The induced low pressure behind the tip of the catheter—or the outlet of the nozzle in the laryngoscope—entrains surrounding air, which ventilates the patient. HFJV and SHFJV have several major advantages. SHFJV has an even better visualization and instrumental presentation than HFJV, as the catheter used in HFJV might impede visualization of the larynx. SHFJV is especially
F. G. Dikkers (*) Department of Otorhinolaryngology, University Medical Center Groningen, University of Groningen, P.O. box 30.001, 9700 RB Groningen, The Netherlands e-mail: [email protected] G. Krenz · G. B. Eindhoven Departement of Anaesthesiology, University Medical Center Groningen, University of Groningen, P.O. box 30.001, 9700 RB Groningen, The Netherlands D.-J. Slebos Department of Pulmonology, University Medical Center Groningen, University of Groningen, P.O. box 30.001, 9700 RB Groningen, The Netherlands
Fig. 1 Emergency diagnostic and therapeutic procedure using SHFJV in 51-year-old male with subglottic benign polyp, obstructing the airway in cricoid
13
Eur Arch Otorhinolaryngol
helpful during laser procedures of the larynx and trachea. Experience and vigilance of both the surgical and anesthesia team are paramount for safe procedures. Conflict of interest The authors have no conflicts of interest.
Reference 1. Li Y, Peng A, Yang X, Xiao Z, Wu W, Wang Q (2014) Clinical manifestation and management of primary malignant tumors of the cervical trachea. Eur Arch Otorhinolaryngol 271(2):225–235. doi:10.1007/s00405-013-2429-9
Fig. 2 Emergency diagnostic procedure using SHFJV in 69-year-old male with neuro-endocrine carcinoma, 7 cm from glottis
Fig. 3 Elective procedure using SHFJV in 13-month-old patient with Down syndrome, with post-intubation distal tracheal stenosis. The cryo-probe used here has a circumference of
