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"A higher air flow and, therefore, higher oxygen concentration, a wider space to facilitate the surgeon's intervention in the most complicated anatomical areas, as well as a close monitoring of ventilation during the procedure are the differential characteristics offered by the new jet ventilation system, compared to conventional respiratory equipment," explains Dr. Rafael Moncada, specialist of the department of Anesthesia and Intensive Care of the Clínica Universidad de Navarra. The hospital has recently incorporated this state-of-the-art respiratory equipment in numerous surgical procedures.

The first patient to use the advanced Jet ventilation equipment was a Cuban hospital nurse manager , who underwent surgery at the Clinic by a team of thoracic surgeons led by Dr. Wenceslao Torre, director of department. The patient had an endobronchial tumor, very close to the area of the trachea that bifurcates into the two bronchi (tracheal carina). This is a rare tumor subject whose location represents an added difficulty. "The tumor was located in a very complex anatomical position. It is a space that is difficult to access so that the anesthesiologist could ventilate the patient with the trachea open. A problem that we were able to solve thanks to the Jet ventilation system," says Dr. Moncada. The procedure," he notes, " could have also been performed with conventional equipment and, possibly, the need for extracorporeal circulation. But we would have had more difficulties and increased the risks for the patient. The new ventilator greatly facilitated the surgical approach and the safety of procedure".

In this case, the use of the ventilator was particularly important because of the thinner cannulae (smaller diameter than conventional cannulae) needed to introduce airflow through the patient's respiratory tract during the procedure. " By incorporating much finer cannulas, the respiratory equipment made it easier for the surgeon to access the tumor and the tracheobronchial anastomosis (junction or suture)," specifies Dr. Moncada.

Outstanding features

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The Jet ventilation system, which emits a greater flow of air, already existed previously. However, the new equipment acquired by the Clinic incorporates relevant novelties. These include different models of cannulas that allow their adaptation to different anatomical areas and, therefore, their use in different types of surgeries.

Also important is the high frequency of air flow emission, which increases the number of ventilations per minute issue , "to facilitate and improve the patient's oxygenation during the operation, while at the same time allowing this frequency to be modulated as appropriate in each case," says the specialist. subject In addition, for certain endobronchial surgeries, the new equipment can even ventilate the lung on which the operation is performed, "which is a great advantage in this type of surgery," he adds.

The new equipment, marketed by an Austrian signature , provides different surgical parts compatible with the new ventilator device, including specific instruments for performing bronchoscopies and laryngoscopies and the system for monitoring the patient during the operation.

Indications

Leonor Veiga Gil (Anesthesia), Akiko Tamura Ezcurra (Thoracic Surgery), Rafael Moncada Durruti (Anesthesia), Wenceslao Torre Buxalleu (director Thoracic Surgery) and Elisabeth Stoll (Anesthesia).

Photo: Manuel Castells

At Clínica Universidad de Navarra, the specialists at department of Anesthesia and Intensive Care already use the jet ventilation device on a regular basis in thoracic, larynx and vocal cord (ENT) surgeries.

In general, thanks to the different types of cannulae and parts incorporated in the new model, the range of indications for which it can be used has been extended. According to Dr. Moncada, due to this instrumental variety, the device is compatible, among others, with the bronchial ventilation required for bronchoscopies, especially with complex techniques in which the patient's correct ventilation may be endangered.

Surgeries at specialization program ENT surgeries also benefit from the advantages of this ventilator, as well as patients with pulmonary pathology admitted to critical care units. Likewise, it provides advantages in numerous thoracic surgeries on patients with little respiratory reservation ,"in whom the existence of a very pathological lung puts correct oxygenation at risk," the anesthesiologist points out.

As for the new pieces it incorporates, those indicated for bronchoscopies, special cannulas for laryngoscopy and, especially, for vocal cord surgery, should be highlighted. It also provides a T-shaped piece, indicated to adapt to endotracheal tubes and laryngeal masks, used in thoracic surgeries in which only one lung is ventilated while the other one is being operated on (double-lumen tubes). The device also has multi-lumen cannulas used in tracheal section ventilations, tracheal stenosis (narrowing) and tracheal surgeries in general. Overall, the specialist points out, "it is a jet ventilation system that offers important advantages and a wide variety of uses".

With respect to the patient, this ventilation system reduces the time of some surgeries by facilitating surgical access. In this sense, it increases the safety of the operation thanks to the ability to provide a greater volume of oxygen as needed at any given moment. The ability to adequately ventilate the lung surgery patient is an important benefit because it reduces the risk of postoperative lung damage.

Interview with patient Lázaro Luis Hernández Vergel