[Emergency translaryngeal ventilation].
Every anesthesia providers is aware of the serious consequences of anoxia subsequent to acute airway obstruction, and is trained to manage such situations when they occur. Nonetheless, a patent airway is not always attainable. Percutaneous needle laryngostomy with translaryngeal ventilation has been widely advocated for emergency ventilation in desperate situations in which other efforts, including intubation have failed. A review of literature suggested that using a large bore (> 18 Ga) needle/catheter with a jet ventilator, or alternatively connecting it to an oxygen source of high pressure (40-50 psi; i.e. anesthesia machine, wall outlet etc.) via a low compliance tubing will effectively resuscitate an animal or patient. However, this method may expose the patients to the risk of barotrauma which has inhibited its widespread adoption. In order to assess this risk, we have conducted an in vitro study employing a simple lung simulator and an anesthesia machine. Variables of the experiment included the make of the anesthesia machine, size of the needle/catheter, degree and duration of depression of the flush valve, as well as the size of the pop-off valve opening. Based on the data obtained from our study as well as others by an extensive literature review, we have proposed some guidelines for this technique when a jet ventilator is not available.
Dept. of Anesthesiology, Charlés R. Drew University of Medicine and Science, Los Angeles, California.
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King
D000402:Airway Obstruction / Q000628:therapy; D004630:Emergencies; D006801:Humans; D007830:Larynx; D012121:Respiration, Artificial / Q000379:methods*; D012122:Ventilators, Mechanical