Pokryshen D. Application of high frequency jet ventilation in endoscopic microlaryngeal procedures for bilateral vocal cord paralysis

Dissertation focuses on improving the anaesthetic management of endoscopic microsurgical interventions for bilateral vocal cord paralysis (BVCP) by means of applying subglottic high frequency jet ventilation (HFJV) as a method of respiratory support. In the present thesis, we intended to establish appropriateness of subglottic high frequency jet ventilation as a method of respiratory support during microsurgical interventions for BVCP. The purpose of our study was to systematically compare subglottic high frequency jet ventilation with conventional mechanical ventilation in relation to oxygenation and carbon dioxide elimination. We also sought to confirm safety and relevance of subglottic HFJV in the presence of BVCP by assessing complication rates, surgical working conditions and overall nursing workload in the postoperative period. We also intended to investigate whether subglottic HFJV during laryngeal microsurgery for BVCP would result in better surgical outcomes comparing to conventional artificial ventilation delivered via tracheostomy tube. In summary, our findings indicate that subglottic high frequency jet ventilation is effective and safe method of respiratory support during laryngeal microsurgery for BVCP as it provides optimal surgical working conditions and ensures low complication rates. It was also confirmed that preventive tracheostomy prior to endoscopic chordarythenotomy is the major independent risk factor of extended stay in hospital for patients with BVCP. Therefore, we have further evolved a method of respiratory support for endoscopic surgical repair of BVCP that is based upon subglottic HFJV and does not require routine surgical access to airways.