title: Transtracheal ventilation with a novel ejector-based device (Ventrain) in open, partly obstructed, or totally closed upper airways in pigs.
abstract: BACKGROUND
  Transtracheal access and subsequent jet ventilation are among the last options in a 'cannot intubate-cannot oxygenate' scenario. These interventions may lead to hypercapnia, barotrauma, and haemodynamic failure in the event of an obstructed upper airway. The aim of the present study was to evaluate the efficacy and the haemodynamic effects of the Ventrain, a manually operated ventilation device that provides expiratory ventilation assistance. Transtracheal ventilation was carried out with the Ventrain in different airway scenarios in live pigs, and its performance was compared with a conventional jet ventilator.
  
  
  METHODS
  Pigs with open, partly obstructed, or completely closed upper airways were transtracheally ventilated either with the Ventrain or by conventional jet ventilation. Airway pressures, haemodynamic parameters, and blood gases obtained in the different settings were compared.
  
  
  RESULTS
  Mean (SD) alveolar minute ventilation as reflected by arterial partial pressure of CO2 was superior with the Ventrain in partly obstructed airways after 6 min in comparison with traditional manual jet ventilation [4.7 (0.19) compared with 7.1 (0.37) kPa], and this was also the case in all simulated airway conditions. At the same time, peak airway pressures were significantly lower and haemodynamic parameters were altered to a lesser extent with the Ventrain.
  
  
  CONCLUSIONS
  The results of this study suggest that the Ventrain device can ensure sufficient oxygenation and ventilation through a small-bore transtracheal catheter when the airway is open, partly obstructed, or completely closed. Minute ventilation and avoidance of high airway pressures were superior in comparison with traditional hand-triggered jet ventilation, particularly in the event of complete upper airway obstruction.
authors.affiliation: Department of Anaesthesiology and Intensive Care Medicine, Jena University Hospital, Erlanger Allee 101, 07747 Jena, Germany markus.paxian@med.uni-jena.de.
authors.forename: M
authors.initials: M
authors.lastname: Paxian
authors.affiliation: Department of Anaesthesiology and Intensive Care Medicine, Jena University Hospital, Erlanger Allee 101, 07747 Jena, Germany.
authors.forename: N P
authors.initials: NP
authors.lastname: Preussler
authors.affiliation: Department of Anaesthesiology and Intensive Care Medicine, Jena University Hospital, Erlanger Allee 101, 07747 Jena, Germany.
authors.forename: T
authors.initials: T
authors.lastname: Reinz
authors.affiliation: Department of Anaesthesiology and Intensive Care Medicine, Jena University Hospital, Erlanger Allee 101, 07747 Jena, Germany.
authors.forename: A
authors.initials: A
authors.lastname: Schlueter
authors.affiliation: Department of Anaesthesiology and Intensive Care Medicine, Jena University Hospital, Erlanger Allee 101, 07747 Jena, Germany.
authors.forename: R
authors.initials: R
authors.lastname: Gottschall
mesh_terms: D000402:Airway Obstruction / Q000097:blood / Q000503:physiopathology / Q000628:therapy*; D000403:Airway Resistance; D000818:Animals; D002245:Carbon Dioxide / Q000097:blood; D002496:Central Venous Pressure; D005260:Female; D006439:Hemodynamics; D007442:Intubation, Intratracheal; D010100:Oxygen / Q000097:blood; D012121:Respiration, Artificial / Q000295:instrumentation*; D013552:Swine
chemical_list: D002245:Carbon Dioxide; D010100:Oxygen
keywords: airway obstruction; equipment, ventilator; ventilation, transtracheal