title: Percutaneous dilational tracheostomy (PDT) and prevention of blood aspiration with superimposed high-frequency jet ventilation (SHFJV) using the tracheotomy-endoscope (TED): results of numerical and experimental simulations.
abstract: We describe an innovative computer-based method for the analysis of gas flow using a modified airway management technique to perform percutaneous dilatational tracheotomy (PDT) with a rigid tracheotomy endoscope (TED). A test lung was connected via an artificial trachea with the tracheotomy endoscope and ventilated using superimposed high-frequency jet ventilation. Red packed cells were instilled during the puncture phase of a simulated percutaneous tracheotomy in a trachea model and migration of the red packed cells during breathing was continuously measured. Simultaneously, the calculation of the gas-flow within the endoscope was numerically simulated. In the experimental study, no backflow of blood occurred during the use of superimposed high-frequency jet ventilation (SHFJV) from the trachea into the endoscope nor did any transportation of blood into the lower respiratory tract occur. In parallel, the numerical simulations of the openings of TED show almost positive volume flows. Under the conditions investigated there is no risk of blood aspiration during PDT using the TED and simultaneous ventilation with SHFJV. In addition, no risk of impairment of endoscopic visibility exists through a backflow of blood into the TED. The method of numerical simulation offers excellent insight into the fluid flow even under highly transient conditions like jet ventilation.
authors.affiliation: Department of Anesthesiology and Intensive Care Medicine, Emergency Medicine and Pain Management, Dresden Friedrichstadt Hospital, Dresden University Teaching Hospital, Dresden, Germany. nowak-an@khdf.de
authors.forename: Andreas
authors.initials: A
authors.lastname: Nowak
authors.forename: Robin
authors.initials: R
authors.lastname: Langebach
authors.forename: Eckart
authors.initials: E
authors.lastname: Klemm
authors.forename: Winfried
authors.initials: W
authors.lastname: Heller
mesh_terms: D001769:Blood; D003198:Computer Simulation; D004867:Equipment Design; D019544:Equipment Failure Analysis; D006611:High-Frequency Jet Ventilation / Q000295:instrumentation* / Q000379:methods; D006801:Humans; D008954:Models, Biological; D053120:Respiratory Aspiration / Q000209:etiology / Q000517:prevention & control*; D014139:Tracheostomy / Q000009:adverse effects / Q000295:instrumentation*; D016896:Treatment Outcome