Grassetto et al. 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. J Anesth Analg Crit Care 2022

This publication by Dr. Grassetto and colleagues focuses on Tritube and Evone for laryngotracheal surgery, combining a retrospective observational study with an exhaustive narrative review of the existing literature. A series of 21 patients with various lung conditions undergoing different laryngotracheal surgery procedures was evaluated, including five patients with obesity, four with COPD, and one patient with a history of Covid-19. While Tritube was easily intubated and resulted in overall excellent surgical conditions, individually optimized flow-controlled ventilation facilitated adequate ventilation in all patients using relatively low minute volumes and global alveolar driving pressures. Only the post-Covid-19 patient – with severely affected lung condition – required a rather high driving pressure (23 cmH2O), yet with a low minute volume (7.4 L/min), to achieve acceptable oxygenation and normocapnia. The narrative systematic review describes and evaluates 13 clinical studies and reports on flow-controlled ventilation delivered with Tritube during upper airway surgery, with a focus on clinical benefits and potential drawbacks. While appropriate device-specific training, including the handling of tube obstructions, is mentioned to be crucial for safe and adequate application of flow-controlled ventilation, several advantages of Tritube and Evone over conventional techniques are highlighted. The authors conclude that this approach ‘may represent an ideal approach that benefits surgeons, anesthesiologists, and patients with difficult airways and compromised lung mechanics.’