Use of high flow oxygen (HFO) for difficult airway management in Jael syndrome: a case report

Abstract

: Jael Syndrome is defined as an intentional craniofacial stab injury. There are few cases in the medical literature describing such facial impalements with the presence of the instrument in the face. Such cases present a complex challenge, involving many specialities, and in particular requires cautious considerations in the immediate preoperative management and intubation of such patients. The use of High Flow Oxygen (HFO) has an increasingly popular role in anaesthetic and intensive care practices, with numerous studies supporting its efficacy in preoxygenation and increasing the safe apnoea time prior to intubation. We report the case of a 20 years old man who presented with facial impalement with a kitchen knife following an altercation. Imaging confirmed that the knife passed through the nasopharynx and was embedded in his right occipital condyle. He was transferred to theatre, where prior to the removal of the implement and haemostasis control, he was preoxygenated using (HFO) and his airway secured with video laryngoscopy. Post operatively, he was kept sedated and ventilation in the Intensive Care Unit (ICU) prior to being successfully extubated and transferred to the ward. He was subsequently discharged form hospital with only mild sensory loss secondary to the injury. This case highlights the technical difficulties associated with the preoxygenation and intubation in patients presenting with facial impalement, and in particular use of HFO in providing for an extended safe apnoea time prior to securing a difficult airway in the context of maxillofacial trauma.