Physiological effects of translaryngeal open ventilation in patients with restrictive respiratory disorders.
OBJECTIVE
To compare the efficacy of pressure-controlled ventilation (PCV) delivered through a conventional endotracheal tube with the same ventilatory mode using a small-size tube with the cuff left deflated (translaryngeal open ventilation: TLOV).


METHODS
A medical-surgical intensive care unit (ICU).


METHODS
Prospective physiological study.


METHODS
Thirteen consecutive patients with restrictive neuromuscular and thoracic respiratory disorders ventilated in pressure-controlled mode.


METHODS
The standard tube was removed and a microlaryngeal tube (i.d. 4 mm, o.d. 6 mm, length 380 mm) was inserted with the cuff left deflated. PCV was increased to match the tracheal pressure measured during conventional ventilation. Arterial blood gases were measured before, 1 h and 20 h after initiating TLOV. A patient comfort score was measured by a visual analogue scale during conventional ventilation and 20 h after initiating TLOV (0= very bad, 1= bad, 2= quite bad, 3= sufficient, 4= good, and 5= very good).


RESULTS
Inspiratory pressure was significantly increased from 16+/-5 cmH(2)O to 68+/-13 cmH(2)O after 1 h and to 65+/-12 cmH(2)O after 20 h to match the tracheal pressure measured during conventional ventilation (CV) (p<0.005). No statistically significant differences were found in arterial blood gases and patient's respiratory rate before and after 1 and 20 h of TLOV. The comfort score was 1.3+/-0.4 and 3.6+/-0.4 during CV and TLOV, respectively, on a scale from 0 to 5 (p<0.002).


CONCLUSIONS
This study indicates that, in selected patients, TLOV was as efficient as conventional PCV.
Gregoretti
Cesare
C
Servizio di Anestesia e Rianimazione - CTO, Via Zuretti 29, 101028 Torino, Italy. 3358394262@tim.it
Navalesi
Paolo
P
Biolino
Piera
P
Racca
Fabrizio
F
Silvestri
Antonio
A
Confalonieri
Marco
M
D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D007442:Intubation, Intratracheal / Q000379:methods*; D007558:Italy; D007830:Larynx / Q000502:physiology*; D008297:Male; D008875:Middle Aged; D011175:Positive-Pressure Respiration / Q000379:methods*; D011446:Prospective Studies; D012120:Respiration Disorders / Q000628:therapy*; D016896:Treatment Outcome