Tube-In-Tube Salvage Utilizing Positive-Pressure Ventilation During Open-Tube Rigid Bronchoscopy with Jet Ventilation: A Retrospective Study

Background: Intraprocedural hypoxemia remains a common challenge during open-tube jet ventilation via rigid bronchoscopy, potentially necessitating conversion to alternative airway strategies. We evaluated patient factors associated with hypoxemia and the feasibility of a tube-in-tube salvage utilizing the positive-pressure ventilation technique. Methods: A retrospective single-center review of rigid bronchoscopies was performed between January 2024 and July 2026. Refractory hypoxemia was defined as oxygen saturation < 90% for >120 s or the need to abandon jet ventilation for an alternative ventilation strategy. Patient demographics, procedural characteristics, and airway management outcomes were analyzed. Results: A total of 235 rigid bronchoscopies were reviewed, of which 37 (15.8%) were complicated by refractory hypoxemia. Patients developing hypoxemia had higher body mass index (30.4 ± 7.6 vs. 26.2 ± 11.0 kg/m2, p = 0.006) and longer procedure duration (76.4 ± 35.1 vs. 48.1 ± 29.9 min, p < 0.001) compared with non-hypoxemic patients. Among hypoxemic patients, 12 underwent tube-in-tube salvage and 25 received alternative management. Tube-in-tube salvage successfully restored oxygenation without airway conversion in all patients (12/12, 100%). In contrast, 12 of 25 patients (48%) managed without tube-in-tube salvage required conversion to an alternative airway strategy (p = 0.003). Conclusions: Refractory hypoxemia remains a common occurrence during open-tube jet ventilation and was associated with higher BMI and longer procedure duration. Tube-in-tube salvage utilizing positive-pressure ventilation was feasible, avoided additional airway manipulation, and allowed for the continuation of planned procedures. Larger, prospective studies are needed to further evaluate safety and efficacy.