Skip to main content

Table 3 Overview and summary of published clinical data using Tritube and FCV in upper airway surgery

From: A new perspective during laryngo-tracheal surgery: the use of an ultra-thin endotracheal tube (Tritube®) and flow-controlled ventilation—a retrospective case series and a review of the literature

Reference

Type

Aim/purpose

Conclusions on Tritube and FCV

Adverse events

Kuut et al (2022) [19]

Prospective observational study (ten patients, data on eight patients reported)

To assess the use of Tritube and FCV in patients with end-to-end anastomosis who had required cross-field intubations in the past.

- Allows intubation in narrowed trachea and adequate ventilation

- Avoids the need for cross-field intubation during tracheal anastomosis in most cases

- Provides favorable conditions for visual assessment of anastomosis and laryngeal edema following surgery

- Primary choice for tracheal surgery

- One cross-field intubation needed due to too weak fixation of Tritube, which was solved after nasal placement of Tritube

- One reintubation with another Tritube due to cuff damaged by surgeon.

- 14 tube obstructions due to surgical manipulation (six times), secretions (five times), kinking outside of the patient (once), and unknown (twice), which could be solved all times by stopping manipulation or by flushing using saline.

Filauro et al (2022) [20]

Case series (five patients)

Laryngotracheal surgery in five patients, including idiopathic subglottic stenosis (n=2) and RRP with subglottic stenosis (n=3)

- Can potentially overcome all the drawbacks of HFJV, providing stable and safe ventilation

- Increases exposure of the working space for the surgeon

- Preserves the airways from bleeding

- Protects the surgical team from viral aerosolization during RRP surgery

None

Mallam et al (2022) [21] response by Böttinger et al (2022) [22]

Case report

Management of a near total intrathoracic airway obstruction and its debulking.

- Valuable to manage severe airway obstructions, especially when jet ventilation and ECMO are contra indicated.

- Sufficient training is demanded

- Technical errors on Evone (now corrected by software updates)

- Ventilatory problems likely related to mispositioning of Tritube

- Difficulties in handling Ventrain likely due to the stressful situation

Leow et al. (2022) [23]

Case report

Resection of chondrosarcoma deriving from left arytenoid by means of anterior laryngofissure.

- Allows intubation of the narrowed lumen

- Adequate ventilation

- Avoids a (temporal) tracheostomy.

None

Bialka et al. (2022) [24]

Case report

Tracheal resection due to severe stenosis after being ventilated due to COVID-19-related ARDS.

- Allows intubation of the narrowed trachea

- Provides excellent surgical exposure

- Stable and adequate ventilation by FCV

- Avoids cross-field intubation

None

Ankay Yilbas et al. (2021) [25]

Case series (three patients)

Three patients undergoing airway surgeries. (1) Emergency debulking surgery and diagnostic biopsy in a patient with a laryngeal mass narrowing the lumen for 80%. (2) Tracheal dilatation in a patient with a history of post-intubation related tracheal resection. (3) Uvulopalatoplasty in an obese patient with severe obstructive sleep apnea.

- Allows intubation in difficult airway

- Provides a great surgical exposure

- Provides adequate ventilation

Once a short-term obstruction of Tritube with secretions occurred in the third patient, which was resolved after flushing with saline

Bailey et al. (2021) [26]

Case report

Total laryngectomy to resect a stage 4 transglottic squamous cell carcinoma. With a minimum diameter of 2 mm left.

- Permits the surgeons to maintain a closed system during much of the procedure, including during fashioning of the stoma

- Avoids need for multiple extubations and periods of apnea

- Allows intra-operative assessment of the subglottic tumor

- Allows for excellent gas exchange throughout procedure

- Avoids awake or emergency tracheostomy

None

Shallik et al. (2021) [27]

Case report

Total thyroidectomy for a malignant, invasive, and highly vascularized thyroid carcinoma that had invaded the surrounding tissues, including the trachea (4-mm-diameter left).

- Allows intubation of a severely narrowed trachea

- Provides adequate ventilation using FCV

- Avoids the need for ECMO

None

Meulemans et al. (2020) [28]

Prospective observational study (15 patients)

To evaluate feasibility and safety of FCV ventilation using Evone and Tritube in difficult upper airway surgery.

Compared to HFJV, Tritube with FCV:

- Allows superior visualization, accessibility and visibility of surgical site

- Safe and stable ventilation in all cases

- Without the risk of aspiration.

- Likely to be time-saving, as it avoids quick desaturation and consecutive surgery pauses.

None

Schmidt et al. (2019) [29]

Randomized controlled trial (2 x 20 patients)

To compare FCV ventilation using Evone and Tritube to VCV using a microlaryngeal tube size 6.0 (MLT-6) in patients without expected difficult airway undergoing elective laryngeal surgery.

- Improves visibility of the surgical site

- Improves surgical conditions for users with lower level of expertise

- Improves lung aeration and respiratory system compliance

- One Tritube disclocation caused by coughing

- One ventilator failure due to software malfunction

Schmidt et al. (2019) [30]

Prospective observational study (15 patients)

To provide assessment of Tritube and FCV in mechanically ventilated lung-healthy patients undergoing ENT surgery

- Allows easy intubation

- Contributes to the armamentarium for airway management

- Achieves adequate etCO2 levels with minute volume and driving pressures in the normal range

- Four tube dislocation (two from coughing, two from external manipulations)

- One tube obstruction solved by flushing with saline

Piosik et al. (2018) [31]

Case report

Stepwise synecchia reduction with laser, cold steel instruments and mitomycin C in a patient with severe glottic stenosis upon a history of recurrent laryngeal papillomatosis.

- Facilitates tracheal intubation without compromising the surgical access

- Offers prolonged ventilation

None

Jeyarajah and Ahmad (2018) [32]

Case report

Awake intubation to allow panendoscopy in a patient with limited neck extension, a mouth opening of 3 cm, Mallampati score of 3, radiotherapy changes to the neck and COPD.

- Uneventful awake intubation under fiberoptic guidance

- Optimal surgical access

- Adequate ventilation, with CO2 monitoring

None

  1. Abbreviations: FCV flow-controlled ventilation, HFJV high-flow jet ventilation, RRP recurrent respiratory papillomatosis, ECMO extracorporeal membrane oxygenation, COVID-19 coronavirus disease-19, ENT ear-nose-throat, etCO2 end-tidal carbon dioxide