The use of a jet ventilation
would be an alternative, but owing to the risk of complete airway obstruction in view of the extent of the stenosis, passive outlet of the insufflated air was not guaranteed.
reported that EBUS-TBNA with rigid bronchoscopy, jet ventilation
, and general anesthesia was performed efficiently and safely in 105 cases.
Although the endoeSL can also provide a precise suture placement, a videoendoscope and a special designed instrument , seem to be crowded inside the limited laryngoscopic space, and consequently, the use of jet ventilation
seems to be unavoidable.
Non-conventional modes of ventilation and oxygenation like high frequency jet ventilation
(HFJV), extra corporeal membrane oxygenation (ECMO) or ventilation across surgical field are the unique techniques which are often needed for successful ventilation and oxygenation.
Tubeless techniques include intermittent apnoeic ventilation, supraglottic or transtracheal jet ventilation
via a catheter, and THRIVE.
When an impinging jet ventilation
system is used for room heating, the warm supply jet will project to, and then separate from, the floor and rise upward to the ceiling under the effect of buoyancy, leading to a limited spreading distance.
After a surgical pause to assess for bleeding, the endotracheal tube was replaced with jet ventilation
to allow for laser resection of the mass remnant and its underlying mucosa; ten watts of carbon dioxide laser was used on super-pulse mode for the resection.
 reported that high frequency jet ventilation
helped more rapid resolution of pulmonary interstitial emphysema than conventional mechanical ventilation (CMV) but had no significant difference in the outcome analysis of new air leaks.
There are several reports of successful use of both high frequency jet ventilation
(HFJV) and HFOV (3) in the setting of BPF.
Perioperatively ventilation is challenging, some of the methods described in textbooks are1) Oral intubation and cuff distal to the fistula 2) Insertion of a sterile single lumen tube into the opened trachea distal to the area of resection, 3) One lung ventilation in cases of low lying fistulas 4) High Frequency Jet Ventilation
through the stenotic area, or even 5) Use of Cardiopulmonary bypass.5 For oral intubation it is very important to correctly place the TT tube cuff distal to the fistula and proximal to the carina.6 Correct position is confirmed by a fibre optic bronchoscope.
Difficult airway cart including flexible fiberoptic bronchoscopy, laryngeal mask airway of different sizes and types, thyrocricocentesis kit, and percutaneous transtracheal jet ventilation
were available for back-up.