Tracheal gas insufflation

Abstract

SummaryTracheal gas insufflation is a technique in which gas is injected intratracheally during positive pressure ventilation. The fresh gas rinses expired gas from the tracheal tube and anatomical dead space, aiding carbon dioxide elimination. This reduces ventilatory volume and pressure, helping to reduce ventilator-induced lung damage. Complications of tracheal gas insufflation include interference with ventilator function, tracheal damage and barotrauma. Expiratory washout is a variation of tracheal gas insufflation. We designed and constructed an original expiratory washout system and evaluated its safety and performance in lung and animal models. We found that expiratory limb and tracheal tube occlusion tests caused the device to disable itself at acceptable intratracheal pressures. We also demonstrated up to 31% reduction in tidal volume compared with conventional ventilation, supporting the possibility of using this device clinically to lessen volutrauma. We concluded that aspects of this design might alleviate many of the safety concerns of using tracheal gas insufflation.

Instrumental dead space in neonatology, and its elimination by continuous tracheal gas insufflation during conventional ventilation

“…During the 1990s, the effect of CTGI on CO 2 elimination was confirmed (8)(9)(10)(11)(12). Recently, interest has focused on different techniques of tracheal gas insufflation (13)(14)(15)(16), the interaction between CTGI and respiratory support (17)(18)(19)(20)(21), and the relationship of CTGI to lung injury (22)(23)(24). There are not many publications evaluating CTGI in newborn infants.…”

Insuflação de gás traqueal como recurso terapêutico em ventilação mecânica invasiva: revisão sistemática

“…A TGI tem como objetivo minimizar o estresse pulmonar, melhorando as trocas gasosas e reduzindo o volume corrente ventilatório e a pressão. Também melhora o índice volume/minuto, ajudando assim a reduzir a lesão pulmonar induzida pelo ventilador sem a exigência de elevadas pressões ventilatórias, propiciando uma recuperação mais rápida e a eficácia do tratamento 2,[11][12][13] . Existem dois mecanismos principais responsáveis pela redução do CO 2 durante a aplicação da TGI: o proximal, no qual o gás fresco é introduzido próximo à carina, deslocando o gás contido no espaço morto anatômico proximal até a extremidade do cateter no final da expiração; e o distal, no qual a turbulência gerada pelo jato na extremidade do cateter pode elevar a mistura gasosa em regiões distais ao orifício, aumentando ainda mais a eliminação de CO 2 .…”