Percutaneous transtracheal jet ventilation is delivered through a cannula placed in the cricothyroid membrane during a failed airway. Which complication is the greatest concern with this technique and how is it minimised?

• A Barotrauma from inadequate exhalation time, minimised by ensuring chest fall between breaths ✓
• B Aspiration pneumonitis, minimised by cricoid pressure during ventilation
• C Kinked cannula causing hypoxia, minimised by using a rigid bronchoscope instead
• D Hypercapnia, minimised by raising the driving pressure above 4 bar

Explanation

Jet ventilation through a narrow cannula insufflates oxygen at high pressure with no secure exhalation pathway, so upper airway obstruction leads to breath stacking, tension pneumothorax and fatal barotrauma. This is prevented by ensuring complete chest deflation between jets and abandoning the technique if exhalation cannot occur. Raising driving pressure worsens the hazard, killing option D, and aspiration is not the principal risk because gas flows outward through the glottis.

Reference: Miller's Anesthesia, 9th ed.

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Written and medically reviewed by the StethoPrep medical team.