Percutaneous Transtracheal Jet Ventilation: Discussion

Percutaneous Transtracheal Jet Ventilation: DiscussionIn the present study, the success rate of PTJV in raising the pulse O2 saturation to > 90% and allowing a subsequent secure airway was 79%. Sixty-five percent of patients were eventually weaned from mechanical ventilation. Transtracheal resuscitation utilizing a needle is not a new technique for the anesthesiologist, the otolaryngologist,- and the emergency room physician.” PTJV is not popular in the MICU, where the majority of endotracheal intubations in critically ill patients are managed by medical house staff, fellows, internists, pulmonologists, or critical care physicians. In the early 1950s, Jacoby and coworkers used a 14-gauge (inner diameter [ID], 1.5 mm) needle to puncture the trachea of five patients who were extremely difficult to intubate. canadian neighbor pharmacy
Oxygen was then insufflated through the needle while the authors proceeded with tracheostomy or intubation. In 1971, Spoeral and associates combined transtracheal ventilation with high-pressure jet ventilation; the combined procedure was performed electively during anesthesia in 12 patients. These authors demonstrated that normal blood gas levels could be maintained if patients were ventilated transtracheally with intermittent jets of oxygen (30 L/min at 30 psi) through a 16-gauge (ID, 1.2 mm) needle, despite the induction of respiratory paralysis. Several other human studies and case reports in the anesthesia, emergency medicine, and surgical literature have documented the efficacy of PTJV.
PTJV is relatively safe, simple, and requires little experience. Puncture of the trachea at the cricothyroid membrane with a large-bore angiocath can be done readily with little trauma. Pressurized oxygen can be delivered directly from a wall outlet. Inspiration is achieved by the insufflation of pressurized oxygen with the jet ventilator. Expiration is passive secondary to the elastic recoil of the lung and chest wall. Air escapes through the glottic aperture, creating a jet of bubbles at the oropharyngeal structure. In addition, highly pressurized air might keep the collapsed glottic aperture wide open for a subsequent oral endotracheal intubation. This may have been the reason why 20 patients with successful PTJV were subsequently intubated orally using an endotracheal tube without difficulty.

Category: Pulmonary Function

Tags: difficult intubation, jet ventilation, percutaneous transtracheal jet ventilation