[Continuous flow apnoeic ventilation via intratracheal oxygen insufflation].
BACKGROUND
In patients with disturbed gas-exchange (e.g. COPD) intratracheal oxygen insufflation (ITO2) improves oxygenation and reduces the minute ventilation. We use a bronchoscopic technique of intratracheal catheter placement in unintubated patients. In a patient with a pink-puffer emphysema after endoscopical insertion of the catheter ITO2 induced a "continuous flow apnoeic ventilation" (CFAV).


METHODS
A patient (female, 58 years) with a pink-puffer emphysema was admitted to the ICU with acute on chronic respiratory failure due to acute laryngitis. Because of laryngitis associated upper airway obstruction a non-invasive mechanical ventilation could not be performed. The ensuing high flow ITO2 (10 l/min) induced a CFAV characterized by no chest wall movement and adequate ventilation as reflected by stable, elevated PaCO2 (between 118 and 125 mm Hg), which could be maintained for 4 hours. After an ensuing short-term invasive mechanical ventilation and the administration of high dose glucocorticoids the patient was successfully extubated and the clinical status improved continuously.


CONCLUSIONS
In a patient with an acute on chronic respiratory failure due to end-stage emphysema ITO2 induced CFAV and stabilized the clinical status. Especially in patients with end-stage emphysema, who are likely to be difficult to be weaned from the respirator ITO2 may be a feasible technique in order to bridge an emergency situation.
Osseiran
K
K
Krankenhaus Kloster Grafschaft, Zentrum für Pneumologie, Beatmungs- und Schlafmedizin, Schmallenberg-Grafschaft.
Schönhofer
B
B
Köhler
D
D
D004646:Emphysema / Q000628:therapy; D005260:Female; D006801:Humans; D007327:Insufflation / Q000379:methods*; D007442:Intubation, Intratracheal / Q000379:methods*; D008875:Middle Aged; D010100:Oxygen / Q000378:metabolism*; D012121:Respiration, Artificial / Q000379:methods*
D010100:Oxygen
Apnoische Ventilation infolge intratrachealer O2-Insufflation als probate Intervention bei schwergradiger COPD.