Manual Jet Ventilation in Complex Airway Management: A Case Series including Successful Use in Tracheal Laceration

High-frequency jet ventilation (HFJV) is widely used during rigid bronchoscopy but carries a significant risk of pneumomediastinum in patients with tracheal laceration or compromised airway integrity.This case series describes five patients undergoing rigid bronchoscopy for varied indications-benign tracheal leiomyoma, critical posttracheostomy stenosis, endotracheal tumor with 80% obstruction, esophageal carcinoma with tracheal infiltration, and postsurgical tracheal laceration-successfully managed with manual jet ventilation (MJV) at pressures below 20 psi via the bronchoscope side port.All procedures were completed without major complications.Notably, the patient with a large posterior tracheal wall laceration tolerated MJV without pneumomediastinum or pneumothorax despite an apneic oxygenation time of only 10-15 seconds.Minor complications included vocal cord edema and faucial pillar laceration, both managed conservatively.These findings highlight that low-pressure MJV remains a safe and effective alternative to HFJV in high-risk airway scenarios, underscoring the importance of clinicians maintaining proficiency in this technique.