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Jet ventilation: Complications

Jet ventilation allows for the delivery of oxygen through a high flow device via subglottic jet ventilation tube or 14-16 gauge catheter in cricothyroid membrane. Jet ventilation delivers high flows and small tidal volumes with passive exhalation. Inhalational anesthesia is not possible with jet ventilation, thus these procedures require total intravenous anesthesia (TIVA). It can be performed supraglottic, infraglottic, or transtracheal.

Potential Issues/Complications:

1. Does not provide definitive airway protection against secretions and aspiration

2. Increased risk of airway fire

3. Difficult to monitor end tidal CO2 so it’s difficult to monitor gas exchange/oxygenation unless you are able to draw arterial blood gases (ABGs)

4. Hypercarbia (common): exhalation is passive and requires patent upper airway and sufficient elasticity of the chest wall; dead space ventilation fraction is increased and alveolar ventilation fraction is decreased leading to hypercarbia

5. Laryngospasm (reduced risk if you treat with topical lidocaine)

6. GI insufflation which can result in trauma and/or aspiration

7. Necrotizing tracheobronchitis from excessive mucosal drying if jet ventilation is performed for >2 hours without periodically using atomized saline for lubrication

8. Various traumas related to high pressure gas input: pneumothorax, pneumomediastinum, subcutaneous emphysema, bleeding; more likely in patients with obstructive lung disease due to air trapping and barotrauma

9. Obstruction of airway (common): can be mitigated by use of muscle relaxant to prevent closure of larynx