Percutaneous Transtracheal Jet Ventilation: Trachea

Percutaneous Transtracheal Jet Ventilation: TracheaAfter localizing the cricothyroid membrane, the trachea was stabilized using the thumb and index finger of the nondominant hand. The tip of the angiocath needle, attached to a 10-mL syringe with 5-mL saline solution, was advanced into the tracheal lumen (Fig 1, left, A). Various angiocath sizes were used for cannulating the cricothyroid membrane (Table 1, 2). The free return of air on aspiration through the syringe confirmed the intraluminal position of the tip of the needle (Fig 1, right, B). The angiocath was advanced over the needle into the tracheal lumen. The catheter hub was secured manually to the patient’s skin. The catheter hub was then connected to the hand-operated valve, which, in turn, was connected to a wall outlet that delivered oxygen at a pressure of 50 psi (Fig 2). Ventilation was controlled by manually opening and closing the valve approximately 12 to 20 times per minute. A successful PTJV was defined as the insertion of an angiocath through the cricothyroid membrane into the trachea and restoration of the pulse O2 saturation to > 90% while using high-pressurized oxygen. An unsuccessful PTJV was defined as the inability to insert the angiocath through the cricothyroid membrane or the inability to insufflate oxygen with the jet ventilator. canadian helth& care mall

Results
Tables 1, 2 summarize the characteristics of the patients with successful or unsuccessful PTJV. In these patients, respiratory therapists were unable to oxygenate with bag-mask-valve ventilation, and at least two attempts at conventional endotracheal tube placement were made by medical house staff or the MICU attending physician prior to considering PTJV for immediate oxygenation. Of the 29 patients, the cricothyroid membrane was cannulated successfully and PTJV was applied in 23 patients (79% successful PTJV), while in the remaining 6 patients, catheter insertion and the use of PTJV were difficult (21% unsuccessful PTJV). All initial attempts were made by house staff, followed by the attending physician. The procedure for insertion of the angiocath was done either by medical house staff (in 5 patients) or the MICU attending physician (in 24 patients).

Table 1—Characteristics of Patients With Successful PTJV

PatientNo. Age, yr/ Race/Gender Indication for MV Circumstances No. of ET Attempts Before PTJV Size of Angiocath No. of ET Attempts After PTJV Outcome of Respiratory Failure
1 64/b/m ARDS, sepsis RSI, MA Several 12 gauge 3 Death
2 49/w/m Sepsis, empyema RSI Several 16 gauge 2 Weaned from MV
3 74/b/m RA, COPD exacerbation CPR Several 12 gauge 1 Weaned from MV
4 70/b/m COPD exacerbation, seizure RSI Several 12 gauge 2 Weaned from MV
5 75/b/m RA, COPD exacerbation CPR Several 12 gauge 2 Weaned from MV
6 74/w/m COPD and CHF exacerbation HS Several 6F 2 Weaned from MV
7 64/b/m COPD exacerbation RSI 3 12 gauge 1 Death
8 69/w/m CHF exacerbation RSI 4 14 gauge 1 Weaned from MV
9 69/w/m Sepsis, ESRD RSI Several 12 gauge 3 Weaned from MV
10 80/b/m Sepsis HS 2 6F 2 Death
11 78/b/m CA, renal failure, COPD CPR Several 14 gauge 3 Death
12 68/b/m Sepsis RSI 2 6F 2 Weaned from MV
13 74/b/m Aspiration pneumonia HS Several 6F 3 Weaned from MV
14 57/w/m Acute stroke HS Failed FOB 12 gauge 1 Death
15 67/b/m RA, Postextubation stridor HS Several 6F 3 Weaned from MV
16 52/b/m RA, OSA CPR Several 12 gauge 3 Weaned from MV
17 64/w/m CA, sepsis CPR 3 12 gauge 1 Death
18 57/w/m CA, sepsis CPR 2 6F 1 Weaned from MV
19 71/w/m ARDS RSI 3 6F 1 Death
20 64/w/m ARDS HS 2 12 gauge 1 Death
21 60/w/m CA, sepsis CPR 2 6F 1 Death
22 76/w/m RA, COPD exacerbation CPR 2 12 gauge 1 Weaned from MV
23 67/b/m Stroke, aspiration pneumonia CPR 2 6F 1 Weaned from MV

Table 2—Characteristics of Patients With Unsuccessful PTJV

PatientNo. Age, yr/ Race/Gender Indication for MV Circumstances No. of ET Attempts Before PTJV Size of Angiocath No. of ET Attempts After PTJV Outcome of Respiratory Failure
1 74/b/m CA, AMI, s/p thyroidectomy CPR Several 6F Several Death
2 82/b/m RA, ESRD CPR Several 12 gauge 2 Death
3 64/b/m ICH, sepsis RSI 3 6F 3 Death
4 49/w/m Sepsis RSI Several 6F 1 Weaned from MV
5 52/w/m Self-extubation, RA, ARDS CPR Several 12 gauge Several Weaned from MV
6 50/b/m Sepsis, lung cancer RSI Several 6F 1 Death

 

Figure 1. Left, A and right, B: The steps of insertion of the angiocath through the cricothyroid membrane into the trachea. Reproduced with permission from Patel and Norman.2

Figure 1. Left, A and right, B: The steps of insertion of the angiocath through the cricothyroid membrane into the trachea. Reproduced with permission from Patel and Norman.

Figure 2. The application of jet ventilation. Reproduced with permission from Patel and Norman.2

Figure 2. The application of jet ventilation. Reproduced with permission from Patel and Norman.

Category: Pulmonary Function

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