Complete upper airway obstruction is considered a contraindication for PTJV. In this situation, insufflation of high-pressure gas into the trachea can result in barotrauma. It may be possible to administer pressurized oxygen safely to patients with suspected complete upper airway obstruction or with very severe narrowing of the glottic aperture with the use of Y adapter attached to the catheter hub. The oxygen can be administered through one limb of the Y adapter, while the other limb is used for passive expiration. The ID of the catheter should be 2.8 to 3 mm.
There are a variety of procedures that can be performed for immediate airway protection: crico-thyroidectomy, tracheostomy, fiberoptic intubation, use of a stylet, and use of laryngeal mask airway. All these procedures require experience and are time consuming. Even an emergency tracheostomy takes a few minutes to perform, which can have severe immediate and long-term consequences. PTJV is only a temporary measure to provide the time needed until the airway can be secured. In our patients with successful PTJV, all were subsequently intubated with an oral endotracheal tube, except for one patient whose life was saved with an emergent tracheostomy. The struggle to intubate can waste precious time and can compromise the patient’s cardiorespiratory status. Perhaps early PTJV, rather than multiple, repeated attempts at intubation, would result in less hypoxemia and improved patient outcome. In my opinion, all physicians taking care of critically ill patients who require intubation should become familiar with PTJV. It is important to emphasize that the technique of PTJV is part of the teaching of the difficult-airway algorithm of the American Society of Anesthesiologists for caregivers in the MICU. PTJV is an attractive procedure that adds a degree of comfort to an inexperienced physician who may have problems intubating patients requiring emergent mechanical ventilation. other
Based on the subsequent insertion of an endotracheal tube in the trachea, there were two important benefits for the patients who underwent successful PTJV. First, PTJV provided effective oxygenation while allowing adequate time for upper airway visualization and possible suctioning of oropharyngeal secretions. Second, the subsequent tracheal intubation was easier, possibly because the high tracheal pressure from the gas insufflation opened the collapsed glottis and allowed for better visualization of the glottic aperture.
Standard intubation methods are preferable when they can be performed safely and quickly in patients with acute respiratory failure who require mechanical ventilation. When neither bag-mask-valve ventilation nor endotracheal intubation is feasible, the immediate use of PTJV should be considered, rather than multiple attempts to intubate. PTJV is a quick and safe method to provide immediate oxygenation. Although it is only a temporary measure, it can provide the time needed for a definitive procedure. Even in inexperienced hands, the direct complication rate from insertion of the catheter into the trachea during PTJV is low.