Percutaneous Transtracheal Jet Ventilation: Results

In the group with successful PTJV, the arterial O2 pulse saturation was raised to > 90% immediately and maintained for several minutes with PTJV until the airway was secured. Of the 23 patients with successful PTJV, 20 were subsequently intubated orally without difficulty; in 1 patient, PTJV maintained adequate gas exchange for about 30 min until the surgical team arrived and performed a tracheostomy; in 2 patients, an airway exchange catheter was inserted into the trachea because of a small glottic aperture. The endotracheal tube was slid over the airway exchange catheter. Of the 23 patients with successful PTJV, 14 patients (61%) were eventually weaned from mechanical ventilation after resolution of acute respiratory failure. Nine patients died of multiorgan system failure.
In the group with unsuccessful PTJV, cannulation of cricothyroid membrane was unsuccessful for the following reasons: poor landmarks due to recent thyroidectomy (1 patient); poor landmarks due to obesity with short neck (2 patients); catheter kinking (2 patients); and catheter misplacement because of improper technique (1 patient). In two of the six patients, insertion of an airway exchange catheter was required because of a small glottic aperture. add comment

Both of these patients were weaned from mechanical ventilation. The other four patients, despite successful oral intubation after several attempts, died of multiorgan system failure,
There were no immediate fatalities from the use of PTJV in all 29 patients. In the group of patients with successful PTJV, subcutaneous emphysema resulted in two patients. In two of the six patients with unsuccessful PTJV, severe pneumomediastinum resulted in one patient and subcutaneous emphysema resulted in another patient. There were no major bleeding episodes or infections at the puncture site of the cricothyroid membrane that required specific interventions. Subcutaneous emphysema resolved subsequently without any intervention. Bilateral chest tube placement was required for the severe pneumomediastinum. This patient recovered completely.

Category: Pulmonary Function

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