Physiologic comparison between conventional mechanical ventilation and transtracheal open ventilation in acute traumatic quadriplegic patients.
OBJECTIVE
To evaluate the efficacy of mechanical ventilation administered through a small-bore, uncuffed tracheotomy tube, so-called transtracheal open ventilation (TOV), in comparison with conventional mechanical ventilation via a cuffed tracheal tube (endotracheal invasive ventilation, EIV).


METHODS
Physiologic study.


METHODS
Intensive care unit of a referral trauma center.


METHODS
Ten acute quadriplegic patients.


METHODS
In acute quadriplegic patients receiving EIV, TOV was subsequently applied via an uncuffed, small-bore tube (internal diameter of 4 or 5 mm).


RESULTS
Compared with EIV, arterial blood gases were not significantly different after 1 hr of TOV (Pao2/Fio2, 222.8 +/- 60.9 vs. 218.5 +/- 60.3; Paco2, 37.8 +/- 7.1 torr [5.04 +/- 0.95 kPa] vs. 35.5 +/- 6.8 torr [4.73 +/- 0.91 kPa], for EIV and TOV, respectively). Respiratory rate (19.5 +/- 4.7 vs. 19.6 +/- 5 breaths/min) and inspiratory effort (pressure-time product of esophageal pressure during a 1-min period, 125.9 +/- 48.4 vs. 112.8 +/- 36.4 cm H2O.sec.min) were also no different between the two modes. After 24 hrs of TOV, compared with EIV and TOV after 1 hr, respiratory rate and arterial blood gases remained stable, and the pressure-time product of esophageal pressure during a 1-min period was slightly, but significantly, reduced (83.5 +/- 16.6 cm H2O.sec.min, p < .05).


CONCLUSIONS
In acute quadriplegic patients receiving mechanical ventilation, TOV was as effective as EIV in providing ventilatory support.
Gregoretti
Cesare
C
Intensive Care Unit, Azienda Ospedaliera CTO-CRF-ICORMA, Torino, Italy.
Olivieri
Carlo
C
Navalesi
Paolo
P
D000328:Adult; D000368:Aged; D006801:Humans; D007362:Intensive Care Units; D007442:Intubation, Intratracheal; D008297:Male; D008875:Middle Aged; D011782:Quadriplegia; D012121:Respiration, Artificial / Q000379:methods*; D012984:Software; D014140:Tracheotomy; D014193:Trauma Centers; D014797:Vital Capacity