Archive for the ‘Pulmonary Function’ Category

Percutaneous Transtracheal Jet Ventilation: Conclusion

Percutaneous Transtracheal Jet Ventilation: ConclusionComplete 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. Read the rest of this entry »

Percutaneous Transtracheal Jet Ventilation: Outcome

The most important benefit of PTJV in this study was immediate oxygenation. Throughout the procedure, pulse O2 saturation was maintained at > 90% with the use of PTJV. Arterial blood gas tests were not performed because PTJV was used as temporary, resuscitative procedure until a permanent airway was secured for oxygenation and ventilation. Cote and coworkers have shown that in dogs, adequate ventilation and oxygenation can be obtained using a 12-gauge (ID, 2.8 mm) angiocath needle and a self-inflating bag. Yealy and colleagues have suggested that a 16-gauge or larger angiocath needle, preferably a 12-gauge angiocath needle, should be used when jet ventilation is administered. Read the rest of this entry »

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. Read the rest of this entry »

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. Read the rest of this entry »

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). Read the rest of this entry »

Percutaneous Transtracheal Jet Ventilation: Materials and Methods

At our institution, medical house staff perform oral endotracheal intubation outside the operating room and surgical services. During the MICU rotation, management of the airway is reviewed. This review emphasizes the importance of airway evaluation, preoxygenation using bag-mask-valve ventilation with 100% oxygen, techniques of conventional oral endotracheal intubation on the mannequin, and management of the difficult airway. Equipment for conventional oral endotracheal intubation and the difficult airway are reviewed in the MICU. The difficultairway cart consists of equipment for the PTJV, a fiberoptic bronchoscope, an endotracheal tube exchange tube, and a tracheostomy tray. The placement of the endotracheal tube using the fiberoptic bronchoscope is the responsibility of pulmonary fellow and the MICU attending physician. Surgical management of the airway is the responsibility of the surgical services. comments
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Percutaneous Transtracheal Jet Ventilation

Percutaneous Transtracheal Jet VentilationA 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. Read the rest of this entry »


So Many Advances in Medicine, So Many Yet to Come