High pressure percutaneous transtracheal ventilation: the use of large gauge intravenous-type catheters in the totally obstructed airway.
Percutaneous transtracheal ventilation using a large gauge intravenous-type catheter can be used successfully in the setting of complete upper airway obstruction in animals. In this study, using a large animal model, satisfactory oxygenation and ventilation was achieved by inversely varying the catheter size and the inspiration to expiration ratio (I:E). Specifically, 30 to 63 kg ruminants with an obstructed upper airway were resuscitated for 30 minutes from a hypoxic, hypercarbic, and acidotic state using 12- and 14-gauge catheters connected to a 50 psi oxygen source via a two-way valve with an I:E of 1:4 and 1:9 seconds, respectively. Shorter expiratory time or increased inspiratory time with these intravenous catheters resulted in significant hemodynamic compromise, barotrauma, inadequate carbon dioxide elimination, acidemia, and frequent death.
Stothert
J C
JC
University of Texas Medical Branch, Department of Surgery, Galveston 77550.
Stout
M J
MJ
Lewis
L M
LM
Keltner
R M
RM
D000402:Airway Obstruction / Q000097:blood / Q000503:physiopathology / Q000628:therapy*; D000403:Airway Resistance; D000818:Animals; D001469:Barotrauma / Q000209:etiology; D001784:Blood Gas Analysis; D002408:Catheters, Indwelling; D004195:Disease Models, Animal; D006041:Goats; D006439:Hemodynamics; D006612:High-Frequency Ventilation / Q000009:adverse effects / Q000295:instrumentation* / Q000379:methods; D055370:Lung Injury; D008176:Lung Volume Measurements; D012756:Sheep; D014132:Trachea