Airway Surgery Communication Protocol: A Quality Initiative for Safe Performance of Jet Ventilation.

OBJECTIVES: To assess whether manual jet ventilation can safely be performed with variable anesthesia and operating room (OR) staff experience levels and communication skills.

METHODS: Jet ventilation procedures for airway stenosis at a single institution over 35 months were retrospectively reviewed. OR and anesthesia staff were assigned scores based on experience level and communication skills. Data were analyzed for any association between the experience or communication skills of the staff and the successful use of jet ventilation, complication rate, or ultimate patient outcome, controlling for intraoperative variables and patient and airway complexity. A detailed preoperative surgeon-led communication protocol was followed in all cases.

RESULTS: Seventy procedures in 46 patients were performed. Jet ventilation was successful in 69 of 70 cases. No relationship was found between staff experience or communication scores and the successful use of jet ventilation, complication rate, or ultimate patient outcome. The percentage of cases performed with a fully experienced team was low, at 7.1%. The experience level of the certified registered nurse anesthetist was significantly associated with likelihood of using an adequate paralytic dose upfront (P = 0.017), which in turn correlated with shorter anesthesia time by 19.7 minutes (P = 0.0131); however, neither affected complication rate nor ultimate patient outcome. The statements above remained true in cases of medically complex patients, difficult airways with high degrees of stenosis, and multiple shift changes.

CONCLUSIONS: Manual jet ventilation can be performed safely even in settings of lower staff experience level or communication skills given a surgeon experienced in the technique and a strict communication protocol.

LEVEL OF EVIDENCE: 4 Laryngoscope, 130:S1-S13, 2020.