A Safe, Quick, and Temporary Way To Provide Oxygenation and Ventilation When Conventional Methods Are Unsuccessful
Oral endotracheal intubation is the method of choice in the management of acute respiratory insufficiency. Endotracheal intubation can be difficult to perform in critically ill patients because these patients are often hypoxemic, hypercarbic, and he-modynamically unstable. Unfavorable outcomes, such as death or increased morbidity related to hypoxemia, can occur when adequate gas exchange cannot be maintained with bag-mask-valve ventilation or when an endotracheal tube cannot be inserted into the trachea.
The following difficult situations can occur: when the airway size is overestimated; when there is a less-than-ideal physical working area around the patient; when secretions or blood are present in the oropharynx; when the physician is inexperienced; or when the patient struggles and requires an intervention such as rapid sequence intubation, where the use of muscle relaxant can move the larynx anteriorly, making intubation more difficult. Under these circumstances, percutaneous transtracheal jet ventilation (PTJV) with a large-bore angiocath inserted at the cricothyroid membrane can provide immediate oxygenation from a high pressure (50 lb per square inch [psi]) oxygen wall outlet, as well as ventilation by means of manual triggering. canadian health & care mall
The objective of this retrospective study is to highlight the potential benefit of PTJV as a temporary lifesaving procedure during difficult situations when oral endotracheal intubation is unsuccessful and when bag-valve-mask ventilation is ineffective for oxygenation.
Materials and Methods
The medical records of 29 consecutive patients who underwent PTJV between July 1994 and August 1998 were reviewed. All of the 29 medical patients with acute respiratory failure who required mechanical ventilation underwent immediate PTJV. Using International Classification of Disease Ninth Revision coding, the total number of endotracheal intubations performed in the medical ward, admission office, and ICU was 352 in a 53-month period. The emergent cannulation of the cricothyroid membrane was performed in the admission office or in the medical ICU (MICU) at the Veterans Affairs Medical Center.