High-frequency Jet Ventilation Using a Tube Exchanger® During a Tracheal Stenting Procedure

• Published in: The Journal of the Japan Society for Respiratory Endoscopy Vol. 42; no. 5; pp. 380 - 386
• Main Authors: Matsumoto, Isao, Tamura, Masaya, Takemura, Hirofumi, Yoshida, Shuhei, Takata, Munehisa, Saito, Daisuke, Tanaka, Yusuke
• Format: Journal Article
• Language: Japanese
• Published: The Japan Society for Respiratory Endoscopy 25.09.2020; 特定非営利活動法人 日本呼吸器内視鏡学会
• Subjects: High-frequency jet ventilation; Tracheal stenting; Tube Exchanger; チューブエクスチェンジャー; 気管ステント; 高頻度ジェット換気法
• ISSN: 0287-2137; 2186-0149
• DOI: 10.18907/jjsre.42.5_380

Background. Airway management during tracheal stenting for central airway stenosis is often difficult. We herein report two cases in which high-frequency jet ventilation (HFJV) using a tracheal Tube Exchanger® (TE) proved useful during a tracheal stenting procedure. Case 1. A 33-year-old woman had a rapidly growing metastatic nasopharyngeal small cell carcinoma in the upper-mediastinum that had compressed and narrowed the trachea. She was referred to our department for tracheal stenting. The patient's tracheal tube was removed for the insertion of a tracheal stent by rigid bronchoscopy. This, however, compressed the tumor, thus triggering the sudden onset of airway obstruction. A TE was immediately inserted into the peripheral airway through a guide wire. HFJV was applied through the TE and improved the oxygenation. Subsequently, a self-expanding metallic stent (SEMS) was inserted. Case 2. A 59-year-old woman with a history of colon cancer had tracheal stenosis due to a subglottic metastatic tumor (colon cancer) and was referred to our department for tracheal stenting. A laryngeal mask airway was inserted, and a SEMS was safely deployed; however, the stent migrated to the tracheal bifurcation because of intubation performed to establish the airway, which was necessary due to the occurrence of laryngeal edema. A TE was immediately inserted into the peripheral airway through a guide wire, and HFJV was applied. The stent was successfully repositioned using endoscopic biopsy forceps. Subsequently, a tracheotomy was performed. Conclusion. A TE can be useful option, both as an intubation aid and as a route for HFJV during tracheal stenting.