Comparison of the Effects of High‐Flow Nasal Cannula Oxygen and Jet Ventilation Techniques

ABSTRACT Objectives Shared airway management in endolaryngeal surgery conflicts surgical access with adequate ventilation. This study compared the effects of High‐Frequency Jet Ventilation (HFJV) and Transnasal Humidified Rapid‐Insufflation Ventilatory Exchange (THRIVE) via High‐Flow Nasal Cannula (HFNC) on perioperative oxygenation, arterial CO 2 kinetics, and metabolic stability. Methods In this prospective randomized controlled study, 36 patients (ASA I–II) undergoing elective endolaryngeal procedures were randomized into HFJV ( n = 18) or HFNC ( n = 18) groups. Both cohorts received standardized TIVA and neuromuscular blockade. Primary outcomes were longitudinal PaCO 2 changes at five intervals: baseline (T0), 10 (T1), 20 (T2), 30 (T3) minutes post‐induction, and at surgical conclusion (T4). Secondary outcomes included PaO 2 , pH, and lactate. Results PaCO 2 levels were comparable at T0 and T1. At 20 min (T2), PaCO 2 was significantly higher in the HFNC group (55.5 vs. 44.5 mmHg; p = 0.002). At surgical conclusion (T4), median PaCO 2 reached 66.5 mmHg in the HFNC group versus 44.5 mmHg in the HFJV group ( p < 0.001). Consequently, the HFNC group exhibited significantly lower pH (7.21 vs. 7.31; p < 0.001) and elevated lactate (3.4 vs. 2.5 mmol/L; p < 0.001) at T4. PaO 2 levels at T3 and T4 were significantly superior in the HFJV group ( p < 0.001). Conclusion While HFNC offers an ideal tubeless field for short interventions, its use is limited by time‐dependent hypercapnia and progressive respiratory acidosis. We propose a clinical “20‐min threshold” for HFNC; for longer endolaryngeal procedures, HFJV is preferred to maintain ventilatory and metabolic homeostasis. Trial Registration This clinical trial was registered at ClinicalTrials.gov (registration number NCT05746949). Level of Evidence 2.