Transtracheal Ventilation

Spoerel, W. E.; NARAYANAN, P.S.; SINGH, N.P.

doi:10.1093/bja/43.10.932

Cited by 130 publications

(21 citation statements)

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“…The Venturi principle and the principle of the injector are well known. It has been suggested that when the trachea is used as the diffuser part of the injector, the subatmospheric pressure generated by the jet could occlude the upper airway [10]. This would lead to a sudden increase in the negative deflection of the pressure trace and was not witnessed in any of our patients.…”

Section: Discussionmentioning

confidence: 81%

Measuring tracheal airway pressures during transtracheal jet ventilation: an observational study*

Patel¹,

Diba

2004

Anaesthesia

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SummaryTracheal airway pressures were measured via a transduced fibrescope during transtracheal jet ventilation in 10 patients. Ravussin transtracheal jet ventilation catheters were inserted under local anaesthesia. Following induction of general anaesthesia, tracheal airway pressures were measured at three anatomical levels during fibreoptic intubation. Overall pressure changes during transtracheal jet ventilation were small with the maximal pressure increase (13 mmHg) measured at the carina.Keywords Intermittent positive pressure ventilation: transtracheal jet ventilation. Transtracheal jet ventilation (TTJV) is the 'bottom line' in algorithms for the management of the 'can't ventilate, can't intubate' scenario and is also increasingly used electively both in the management of the anticipated difficult airway and in other situations [1]. For the patient with a difficult airway, our routine practice is the insertion of a TTJV catheter while the patient is awake, followed by induction of anaesthesia, TTJV and the controlled placement of the tracheal tube under fibreoptic guidance. The device of choice for TTJV is the Ravussin jet ventilation catheter (VBM Medizintechnik GmbH, Sulz, Germany) [2,3]. There is however, continuing concern over the risk of barotrauma and pneumothorax from elevated intratracheal pressures during TTJV, as well as the theoretical possibility of entraining secretions and debris based on the Venturi principle. To date there has been no measurement of tracheal airway pressures generated during jet ventilation with this device, and this was the aim of our study. MethodsAn experimental model was devised in order to validate the tracheal airway pressures measured in vivo. A transduced arterial manometer set (8000 Series, Sims Portex, Hythe, UK) was inserted through the rubber diaphragm and into the biopsy channel of an Olympus LF GP fibrescope (KeyMed, Southend-on-Sea, UK). The biopsy channel was then filled with saline to act as a continuation of the manometer set such that pressures could be transduced from the tip of the fibrescope allowing continuous measurement of tracheal airway pressure. The model (Fig. 1) involved the insertion of a transduced fibrescope tip into a flexible catheter mount with 'sealaround-cap' (Intersurgical, Wokingham, UK), connected via a Datex S ⁄ 5 differential pressure pneumotacograph (Datex-Ohmeda, Helsinki, Finland) to a 2 l reservoir bag. The pressure traces from the transduced fibrescope and the respiratory module were recorded simultaneously during ventilation of the reservoir bag. The pressures transduced via the fibrescope correlated extremely well with those measured by the respiratory module (Fig. 2a).A prospective, observational, clinical study was undertaken at the Queen Victoria Hospital. The hospital and Local Research Ethics Committee approved the study protocol and informed written consent was obtained from each participant. Ten consecutive patients requiring TTJV and fibreoptic tracheal intubation as part of their routine anaesthetic management wer...

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Section: Discussionmentioning

confidence: 81%

Measuring tracheal airway pressures during transtracheal jet ventilation: an observational study*

Patel¹,

Diba

2004

Anaesthesia

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“…The technique of transtracheal catheterisation was described some time ago, but it was not until studies by Reed, Jacoby and Jacobs were published that it gained acceptance [24–28]. In 1971, Spoerel was the first to combine percutaneous access to the trachea via the cricothyroid membrane with jet ventilation, which not only permitted adequate oxygenation but also allowed effective carbon dioxide excretion [29]. A publication by Smith in 1975 summarised the first 5 years' experience with Spoerel's technique with the words ‘This technique has established itself as an important adjunct in life support.…”

Section: Discussionmentioning

confidence: 99%

Prophylactic percutaneous transtracheal catheterisation in the management of patients with anticipated difficult airways: a case series*

2005

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Summary Primary tracheostomy under local anaesthesia is indicated in the management of an anticipated difficult airway in patients in whom less invasive procedures are expected to fail or have already failed. However, primary tracheostomy is a relatively complex procedure and places not inconsiderable stress on the patient. In a prospective study in our hospital over a period of 22 months, we were able to avoid primary tracheostomy in 11 patients with very difficult airways. All 11 patients were managed with prophylactically inserted transtracheal catheters and jet ventilation of the lungs. This ensured an adequate oxygen supply during tracheal intubation, and made overall patient management much easier. This method has established itself as a standard procedure in our hospital.

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“…It is a safe, simple, and effective treatment for ventilating a patient when ventilation by mask and intubation cannot be accomplished. 8 It is safe and effective for ventilating patients having surgical procedures of the head and neck. 9 However, it requires identification of the cricoid and thyroid cartilages, the cricothyroid membrane, as well as a patent outflow tract.…”

Section: Discussionmentioning

confidence: 99%