Comparison of Tritube™ tube and Evone® ventilator use with traditional narrow-lumen tube use in microlaryngeal surgery cases

Year 2023, Volume: 6 Issue: 1, 190 - 194, 12.01.2023

Jülide Sayin Kart , Ummahan Dalkilinc Hokenek

https://doi.org/10.32322/jhsm.1220801

Abstract

Aim: To evaluate the feasibility and safety of the Tritube™ tube and Evone® ventilator and compare patients intubated using Tritube™ and ventilated with flow-controlled ventilation (FCV) using Evone® (TT–FCV group) to those intubated using a traditional microlaryngeal intubation tube and ventilated with volume-controlled ventilation (MLT-VCV group) in terms of perioperative parameters and outcomes during microlaryngeal surgery (MLS).
Material and Method: A prospective observational design was conducted. This study was carried out in 6 (six) months between February 2022 and September 2022. After receiving their informed consent, 18 patients were randomly assigned to two groups. Patients older than 18 years, who were scheduled for elective MLS were included in the study. The closed opaque envelope method was used for randomization. The same standard anesthesia protocol was applied to all patients. The patients’ demographic parameters, American Society of Anesthesiology physical status (ASA), Mallampati and Cormack-Lehane scores, duration of ventilation, duration of surgery, hemodynamic parameters, ventilation parameters, and complications were recorded.
Results: Twenty-one patients recruited for the study. Three of them regretted to participate to study. At the end 18 patients were analyzed. The mean age of population was 53(43-62). When the intraoperative respiratory and hemodynamic parameters of the patients were compared between the two groups, the regional cerebral oxygen saturation (rScO2) (p=0.020), tidal volume (p=0.005), compliance of the respiratory system (p=0.001), and post-extubation rScO2 (p=0.001) values were statistically significantly higher in the TT-FVC group compared to the MLT-VCV group. Right rScO2 (p=0.038), left rScO2 (p=0.047), and time to extubation (p=0.021) were statistically significantly lower in the TT-FVC group compared to the MLT-VCV group.
Conclusion: According to the findings we obtained, utilizing Tritube™ and Evone® during MLS surgeries appears to be effective in terms of achieving safe airway management.

Keywords

Microlaryngeal surgery, ventilation, hemodynamics

Supporting Institution

None

Thanks

None

References

• Orlandi E, Alfieri S, Simon C, et al. Treatment challenges in and outside a network setting: head and neck cancers. Eur J Surg Oncol 2019; 45: 40-5.
• Bhat GR, Hyole RG, Li J. Head and neck cancer: Current challenges and future perspectives. Adv Cancer Res 2021; 152: 67-102.
• Schmidt J, Günther F, Weber J, et al. Glottic visibility for laryngeal surgery: tritube vs. microlaryngeal tube: a randomised controlled trial. Eur J Anaesthesiol 2019; 36: 963.
• Grassetto A, Pettenuzzo T, Badii F, et al. A new perspective during laryngo-tracheal surgery: the use of an ultra-thin endotracheal tube (Tritube®) and flow-controlled ventilation—a retrospective case series and a review of the literature. J Anesth Analg Crit Care 2022; 2: 1-15.
• Kristensen M, De Wolf M, Rasmussen L. Ventilation via the 2.4 mm internal diameter Tritube® with cuff–new possibilities in airway management. Acta Anaesthesiol Scand 2017; 61: 580-9.
• Wirth S, Springer S, Spaeth J, Borgmann S, Goebel U, Schumann S. Application of the novel ventilation mode FLow-Controlled EXpiration (FLEX): a crossover proof-of-principle study in lung-healthy patients. Anesth Analg 2017; 125: 1246-52.
• Kuut MH, Honings J, Marres HA, Mourisse JM, Verhagen AF. Controlled mechanical ventilation through a narrow bore lumen during tracheal surgery: A prospective observational study. Eur J Anaesthesiol 2022; 39: 835-7.
• Filauro M, Mora F, Vallin A, et al. Evone® Flow controlled ventilation: a new device for laryngotracheal surgery. Acta Otorhinolaryngol Ital 2022; 42: 189.
• Paxian M, Preussler N, Reinz T, Schlueter A, Gottschall R. Transtracheal ventilation with a novel ejector-based device (Ventrain) in open, partly obstructed, or totally closed upper airways in pigs. Br J Anaesth 2015; 115: 308-16.
• Schmidt J, Wenzel C, Mahn M, et al. Improved lung recruitment and oxygenation during mandatory ventilation with a new expiratory ventilation assistance device: a controlled interventional trial in healthy pigs. Eur J Anaesthesiol 2018; 35: 736.
• Schmidt J, Günther F, Weber J, et al. Flow-controlled ventilation during ear, nose and throat surgery: a prospective observational study. Eur J Anaesthesiol 2019; 36: 327-34.
• Yilbas AA, Melek A, Canbay O, Kanbak M. Experience with Tritube and flow-controlled ventilation during airway surgery. Turk J Anaesthesiol Reanim 2021; 49: 269-70.
• Dos Santos Rocha A, Habre W, Albu G. Novel ventilation techniques in children. Pediatr Anesth 2022; 32: 286-94.
• Mallam L, Massingberd‐Mundy D, Girgis M, De Zoysa N. Near total intrathoracic airway obstruction managed with a Tritube® and flow‐controlled ventilation. Anaesth Rep 2022; 10: 12156.
• Li LT, Chitilian HV, Alfille PH, Bao X. Airway management and anesthesia for airway surgery: a narrative review. Transl Lung Cancer Res 2021; 10: 4631.
• Bailey J, Lee C, Nouraei R, et al. Laryngectomy with a Tritube® and flow‐controlled ventilation. Anaesth Rep 2021; 9: 86-9.
• Magasich‐Airola NP, Martins MR, Desuter GR, Van Boven MJ. Novel technique for safe tracheostomy during COVID‐19 pandemic using Evone® flow‐controlled ventilation system. Int J Clin Pract 2021; 75: 6.
• Medical Ventinova, https://www.ventinovamedical.com/tritube; 14/10/2020. [accessed 14/10/2020.
• Meulemans J, Jans A, Vermeulen K, Vandommele J, Delaere P, Vander Poorten V. Evone® flow-controlled ventilation during upper airway surgery: a clinical feasibility study and safety assessment. Front Surg 2020; 7: 6.
• Mora F, Missale F, Incandela F, et al. High frequency jet ventilation during transoral laser microsurgery for Tis-T2 laryngeal cancer. Front Oncol 2017; 7: 282.
• Bialka S, Palaczynski P, Szuldrzynski K, et al. Flow-controlled ventilation–a new and promising method of ventilation presented with a review of the literature. Anaesthesiol Intensive Ther 2022; 54: 1.
• Weber J, Straka L, Borgmann S, Schmidt J, Wirth S, Schumann S. Flow-controlled ventilation (FCV) improves regional ventilation in obese patients – a randomized controlled crossover trial. BMC Anesthesiol 2020; 20: 24.
• Schmidt J, Wenzei C, Spassov S, et al. Flow-controlled ventilation attenuates lung injury in a porcine model of acute respiratory distress syndrome: a preclinical randomized controlled study. Crit Care Med 2020; 48: 241–8
• Wenzel C, Frey C, Schmidt J, Lozano-Zahonero S, Urban G, Schumann S. A linearized expiration fow homogenizes the compartmental pressure distribution in a physical model of the inhomogeneous respiratory system. Physiol Meas 2020; 41: 045005.
• Sebrechts T, Morrison SG, Schepens T, Saldien V. Flow-controlled ventilation with the Evone ventilator and Tritube versus volume controlled ventilation: a clinical cross-over pilot study describing oxygenation, ventilation and haemodynamic variables. Eur J Anaesthesiol 2021; 38: 209–11
• 26 Van Dessel ED, De Meyer GR, Morrison SG, Jorens PG, Schepens T. Flow-controlled ventilation in moderate acute respiratory distress syndrome due to COVID-19: an open-label repeated-measures controlled trial. Intensive Care Med Exp 2022; 10: 19.
• Wirth S, Seywert L, Spaeth J, Schumann S. Compensating artifcial airway resistance via active expiration assistance. Respir Care 2016; 61: 1597–604.
• Paxian M, Preussler NP, Reinz T, Schlueter A, Gottschall R. Transtracheal ventilation with a novel ejector-based device (Ventrain) in open, partly obstructed, or totally closed upper airways in pigs. Br J Anaesth 2015; 115: 308–16.