Subglottic jet ventilation versus supraglottic jet ventilation for flexible bronchoscopy: a randomized controlled trial.
Summary
In 352 sedated bronchoscopy patients, subglottic jet ventilation significantly lowered hypoxia and severe hypoxia compared with supraglottic jet ventilation, reduced airway rescue maneuvers, and eliminated gastric insufflation events. Safety profiles were otherwise similar.
Key Findings
- Hypoxia incidence reduced from 16.6% to 6.0% with subglottic jet ventilation (RR 0.364, 95% CI 0.18–0.72; P=0.002).
- Severe hypoxia reduced (3.0% vs 8.6%; RR 0.351, 95% CI 0.12–0.95; P=0.030).
- Fewer airway rescue maneuvers: jaw thrust (4.8% vs 12.9%) and mask ventilation (2.4% vs 7.4%).
- No gastric insufflation with subglottic versus 31 events with supraglottic (P<0.001).
Clinical Implications
Prefer subglottic jet ventilation via a dedicated introducer for bronchoscopy under moderate-to-deep sedation to reduce hypoxia and gastric insufflation; prepare fewer airway rescue maneuvers.
Why It Matters
Defines a more effective oxygenation strategy during flexible bronchoscopy, addressing a common cause of intra-procedural instability. The pragmatic RCT supports immediate practice change.
Limitations
- Single-center study may limit generalizability.
- Device- and protocol-specific implementation (SEEK introducer) may affect external adoption.
Future Directions
Multicenter trials to confirm effectiveness across bronchoscopy indications and sedation strategies; evaluation of CO2 clearance and long-term safety.
Study Information
- Study Type
- RCT
- Research Domain
- Treatment
- Evidence Level
- I - Randomized controlled trial with large sample size demonstrating superiority on primary clinical endpoint.
- Study Design
- OTHER