Since the introduction of the supraglottic jet oxygenation and ventilation (SJOV) technique in 2006,[1] it has been increasingly used for various aspects of airway management. The technique has been facilitated largely by the introduction of the jet endotracheal tube[1-3] and the jet nasal tube.[4-18] A large number of studies, including a multicentre randomised clinical trial,[16] demonstrated the high efficiency of SJOV to prevent or treat hypoxia during upper gastrointestinal (GI) endoscopy,[3,8,10,11,14-16,19] colonoscopy,[20] endoscopic retrograde cholangiopancreatography[4] and hysteroscopy,[12] under propofol sedation/anaesthesia, especially in obese patients[11-13,15,21] or in locations with high altitude (e.g., Tibet, China).[8] In a previous analysis of closed claimed liability cases that took place in non-operating rooms, a majority (58%) of the claimed cases were under monitored anaesthesia care (MAC), while 50% of cases were in the GI suite with inadequate oxygenation and ventilation, which was the most common cause of severe complications or patient death (30%).[22] Clearly, prevention of hypoxia and hypoventilation during MAC is critical for patient safety in a GI suite. Compared to high-flow nasal oxygenation (HFNO), SJOV not only promoted oxygenation by increasing the fraction of inspired oxygen (FiO2) and oropharyngeal pressure like HFNO did but was also capable of ventilating patients to eliminate carbon dioxide, especially in patients with apnoea.[3] Furthermore, SJOV is also effective to oxygenate/ventilate patients even when the mouth is open in an open airway system.[3] SJOV has been used to facilitate bronchoscopy under propofol sedation/anaesthesia and prevent or treat hypoxia during the procedure.[5,9] SJOV has been used to maintain oxygenation/ventilation during elective difficult airway management and to facilitate tracheal intubation.[1,2,18,23] The new guideline on difficult airway management by the American Society of Anesthesiologists in 2022 suggested that SJOV could be considered one of the approaches to rescue patients with urgent or emergent difficult airways.[13,17,24] Hence, the SJOV technique has advanced quickly in operating or non-operating rooms to promote oxygenation/ventilation and prevent or treat hypoxia during airway management. Its potential use in treating respiratory failure in emergency or critical medicine needs to be investigated further.
One of the major concerns of using transtracheal jet ventilation (TTJV) during difficult airway management is its high incidence of complications and high failure rate. It was reported that emergent TTJV resulted in barotrauma complications and device failure rate during the ‘cannot intubate and cannot oxygenate’ emergent airway management, at rates as high as 32% and 42%, respectively.[25] In contrast, there has not been a single reported case of barotrauma to date in all studies using the SJOV technique, which has a high success rate in preventing or treating hypoxia/hypoventilation in elective[3-5,8,9,16,18,23] or urgent/emergent[13,17] airway management. This advantage of SJOV in comparison to TTJV is largely due to the placement of the jet pulse above the vocal cord, rather than below the vocal cord, which effectively prevents injection of a high volume of gas into a closed airway system and breakage of alveoli with a rapid increase in abnormal high airway pressure.[3] Common side effects of SJOV are sore throat and dry mouth, with the risk factors being previous history and procedure duration.[26] In almost all studies to date, humidified oxygen or air was not used for SJOV. Dry mouth could be minimised if humidified oxygen/air is used as a driving gas, especially during chronic use of SJOV for respiratory failure. A minor increase in nose bleeding has been reported in cases when a jet tube is employed via the nose for SJOV,[16] although SJOV can be performed by inserting a jet catheter via the mouth beside the hollow bite block used for upper GI endoscopy to minimise the minor complications of nose bleeding.
Overall, the SJOV technique has been advancing rapidly and successfully, especially in MAC cases in a non-operating room, with a high efficiency to promote non-invasive oxygenation/ventilation, causing minimal side effects. The potential use of SJOV in emergency and critical medicine requires further investigation.
Conflicts of Interests
Dr. Huafeng Wei is the inventor of the WEI Jet Endotracheal Tube (WEI JET) and WEI Nasal Jet Tube (WEI NASAL JET or WNJ), which is proposed to generate SJOV used in most clinical studies. Dr. Huafeng Wei is a consult of Well Lead Medical Company, Guangzhou, China.
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