title: Tidal volume and airway pressure under percutaneous transtracheal ventilation without a jet ventilator: comparison of high-flow oxygen ventilation and manual ventilation in complete and incomplete upper airway obstruction models.
abstract: OBJECTIVE
  Percutaneous transtracheal ventilation (PTV) can be life-saving in a cannot ventilate, cannot intubate situation. The aim of this study was to investigate the efficacy of PTV by measuring tidal volumes (VTs) and airway pressure (Paw) in high-flow oxygen ventilation and manual ventilation using a model lung.
  
  
  METHODS
  We examined 14G, 16G, 18G, and 20G intravenous catheters and minitracheotomy catheters. In high-flow oxygen ventilation, the flow was set to 10 L/min, while the inspiratory:expiratory phases (I:E) were 1 s:4 s in the complete upper airway obstruction model and 1 s:1 s in the incomplete obstruction model. In manual ventilation, I:E were 2 s:4 s in the complete obstruction model and 2 s:3 s in the incomplete obstruction model. We ventilated through each catheter for 2 min and measured VT and Paw.
  
  
  RESULTS
  In high-flow ventilation, the average VTs were approximately 150 ml and <100 ml with 14G catheters in complete and incomplete upper airway obstruction, respectively. The VTs obtained were reduced when the bore size was decreased. In manual ventilation, the average VTs were over 300 ml and approximately 260 ml with 14G catheters in complete and incomplete upper airway obstruction, respectively. In high-flow ventilation, the airway pressure tended to be higher. The minitracheotomy catheters produced over 800 ml of VT and created almost no positive end-expiratory pressure.
  
  
  CONCLUSIONS
  High-flow ventilation tends to result in higher airway pressure despite a smaller VT, which is probably due to a PEEP effect caused by high flow.
authors.affiliation: Department of Anesthesia, Nagoya City West Medical Center, 1-1-1 Hirate-cho, Kita-ku, Nagoya, 462-8508, Japan, nobusasano@aol.com.
authors.forename: Nobuko
authors.initials: N
authors.lastname: Sasano
authors.forename: Akemi
authors.initials: A
authors.lastname: Tanaka
authors.forename: Ai
authors.initials: A
authors.lastname: Muramatsu
authors.forename: Yoshihito
authors.initials: Y
authors.lastname: Fujita
authors.forename: Shoji
authors.initials: S
authors.lastname: Ito
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Sasano
authors.forename: Kazuya
authors.initials: K
authors.lastname: Sobue
mesh_terms: D000402:Airway Obstruction / Q000503:physiopathology* / Q000628:therapy*; D004867:Equipment Design; D005260:Female; D006801:Humans; D008168:Lung / Q000502:physiology*; D008297:Male; D008954:Models, Biological; D010100:Oxygen / Q000378:metabolism*; D011175:Positive-Pressure Respiration / Q000295:instrumentation; D012121:Respiration, Artificial / Q000295:instrumentation; D013990:Tidal Volume; D012122:Ventilators, Mechanical
chemical_list: D010100:Oxygen