Physiologic comparison between conventional mechanical ventilation and transtracheal open ventilation in acute traumatic quadriplegic patients*

Abstract

In acute quadriplegic patients receiving mechanical ventilation, TOV was as effective as EIV in providing ventilatory support.

Transtracheal Open Ventilation in Acute Respiratory Failure Secondary to Severe Chronic Obstructive Pulmonary Disease Exacerbation

“…Furthermore, the patients who received transtracheal open ventilation spent significantly fewer days on mechanical ventilation and in the ICU than those who underwent conventional ventilation. Although several observational and physiologic studies have demonstrated the feasibility and the potential advantages of open ventilation (11)(12)(13)(14), this is, to our knowledge, the first randomized controlled trial showing the clinical benefits of delivering mechanical ventilation through an uncuffed tube, compared with the conventional approach based on the use of a cuffed tube.…”

“…Because of the high resistance of the small-bore tube and of the air leaks through the upper airway, the pressure distending the lung during transtracheal open ventilation is actually much less than the pressure applied to the airway opening (11)(12)(13)(14)(25)(26)(27). Uchyiama and colleagues found that a preset inspiratory pressure of 50 cm H 2 O resulted in an actual tracheal pressure of 4-5 cm H 2 O (13).…”

“…Sedation was maintained for 12 h. When spontaneous breathing resumed, patients were switched to pressure support ventilation. All patients were weaned off the ventilator and eventually extubated according to predefined criteria (18,19 (11)(12)(13)(14). Criteria for transtracheal open-ventilation weaning had been predefined (13).…”

“…More recently, the use of pressure-controlled ventilation through a minitracheotomy tube has been reported as an alternative method to provide mechanical ventilatory assistance (11)(12)(13)(14), a technique referred to as transtracheal open ventilation (13). As opposed to NIV, transtracheal open ventilation is free of maskrelated side effects and may facilitate clearance of secretions.…”

The acute respiratory management of cervical spinal cord injury in the first 6 weeks after injury: a systematic review

“…[21][22][23][24][25][26][27] There was moderate evidence to support the use of an assist cough to improve cough efficacy by significantly increasing peak expiratory flow 21 and that the use of trans-tracheal open ventilation (mechanical ventilation through minitracheostomy) 22 was effective in maintaining gas exchange and respiratory mechanics for an initial 24 h period. There was also moderate evidence for the provision of respiratory muscle resistance training to improve maximum inspiratory pressure 24,25 and vital capacity.…”