Supraglottic Jet Oxygenation and Ventilation in Fiberoptic Intubation Training for Anesthesia Residents in a Simulated Difficult Airway: A Randomized Controlled Study

BACKGROUND Simulation-based training is essential for anesthesia residents to learn fiberoptic intubation safely. This study evaluated the effect of Supraglottic jet oxygenation and ventilation (SJOV) on skill acquisition, hypoxemia, and trainee performance during simulated difficult airway training. MATERIAL AND METHODS This prospective randomized study included 20 third-year anesthesia residents without prior fiberoptic intubation experience. Each performed 25 fiberoptic intubations (total=500) on patients wearing a cervical collar to simulate a difficult airway. Residents were randomized to SJOV with 15 pounds per square inch (PSI), 15 breaths/min, fraction of inspired oxygen (FiO₂) 100%, or facemask ventilation. Primary outcomes were the number of cases to achieve procedural competency by cumulative sum (CUSUM) analysis, incidence of hypoxemia [peripheral oxygen saturation (SpO₂) <90%, and competency scores assessed by the Direct Observation of Procedural Skills (DOPS) and Mini-Clinical Evaluation Exercise (Mini-CEX). Secondary outcomes included intubation time and trainee-reported confidence and satisfaction. RESULTS Residents in the SJOV group achieved competency after a median of 11 cases, compared with 18 cases in the facemask ventilation group. Hypoxemia occurred in 0% of the SJOV group versus 10% in the facemask ventilation group (P<0.001). DOPS scores were higher in the SJOV group (P=0.01), while Mini-CEX scores were similar (P=0.64). Residents using SJOV reported greater confidence (P=0.003), engagement (P=0.008), and satisfaction (P=0.012). CONCLUSIONS SJOV accelerates skill acquisition, prevents hypoxemia, and improves performance during simulated difficult airway training. Integrating SJOV into residency programs may enhance the safety and efficacy of fiberoptic intubation training.