Superimposed high-frequency jet ventilation vs. pressure-controlled ventilation in endobronchial ultrasound-guided transbronchial needle aspiration: A randomised controlled trial

Ventilation management during endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is challenging because of shared airway use and the risks of hypoxaemia and hypercapnia. This study compared the safety and efficacy of superimposed high-frequency jet ventilation (SHFJV) and pressure-controlled ventilation (PCV) using a supraglottic airway (SGA) under general anaesthesia. Patients undergoing EBUS-TBNA were randomly assigned to receive either SHFJV or PCV. The primary outcomes was perioperative changes in oxygenation index (OI) . Secondary outcomes included intraoperative hypoxaemia and hypercapnia, perioperative changes pressure of carbon dioxide (PaCO 2 ), haemodynamic stability, intraoperative and postoperative adverse events (AEs), and SGA ventilation quality. All 88 patients (28.4% female; median age, 62 years) were analysed. Overall, 44 participants were randomised to SHFJV, and 44 participants were randomised to PCV. Post-hoc analysis showed that the SHFJV group had significantly greater improvement in OI at the end of surgery (mean difference(MD)=78.52, 95% confidence interval(CI), 30.35 to 126.68), P = 0.039) and a significant decrease in PaCO 2 after 19 minutes (MD= -8.23, 95% CI=-12.68 to -3.77, P =0.001). Intraoperative and postoperative adverse events were similar between the groups, and no significant differences were observed in intraoperative hypoxaemia or hypercapnia. The SHFJV group had fewer cases of poor SGA ventilation quality (4.5%) than the PCV group (20%), demonstrating superior SGA ventilation quality ( P =0.024). SHFJV significantly improved OI compared with PCV while maintaining comparable safety profiles during EBUS-TBNA. These findings underscore the SHFJV as a promising ventilation strategy, particularly for patients requiring improved oxygenation during complex airway interventions. Chinese Clinical Trial Registry; Registration number: ChiCTR2300071799; URL: https://www.chictr.org.cn/showproj.html?proj=197551