Evone(®) Flow controlled ventilation: a new device for laryngotracheal surgery

The success of laryngotracheal surgery is mainly related to adequate exposure of the airway lumen. To render airway surgery more efficient, many efforts have been made in recent decades to obtain a safe ventilation system which uses an orotracheal tube that is as small as possible. The first attempt was made by introducing the high frequency jet ventilation (HFJV) technology in clinical practice. Nonetheless, HFJV has some risks related to the high pressure needed for ventilation in the catheter. First, during HFJV, the expiration of air from the lungs is a passive backflow on the trachea wall, potentially causing hypercapnia and air trapping. Second, HFJV creates an open ventilation system that leads to aerosolisation of airborne particles with an increased infectious risk for the surgeon. To overcome these issues, an innovative flow-controlled ventilation (FCV) system with a narrow-cuffed catheter (Evone(®); Ventinova, Eindhoven, The Netherlands) was introduced in clinical practice. This paper describes our initial experience with the Evone(®) FCV system, reporting the first 5 cases ventilated with this technology. In this observational study, we evaluate the feasibility and safety of the Evone(®) system and deliver a critical appraisal of this novel method of ventilation.