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Percutaneous Transtracheal Ventilation: Resuscitation Bags Do Not Provide Adequate Ventilation

Published online by Cambridge University Press:  28 June 2012

Edmond A. Hooker ,
Daniel F. Danzl ,
Daniel O'Brien ,
Michael Presley ,
Ginger Whitaker  and
M. Keith Sharp
Edmond A. Hooker
Affiliation:
Department of Health Services Administration, Xavier University, Cincinnati, Ohio, USA Department of Emergency Medicine, University of Louisville, School of Medicine, Louisville, Kentucky, USA
Daniel F. Danzl*
Affiliation:
Department of Emergency Medicine, University of Louisville, School of Medicine, Louisville, Kentucky, USA
Daniel O'Brien
Affiliation:
Department of Emergency Medicine, University of Louisville, School of Medicine, Louisville, Kentucky, USA
Michael Presley
Affiliation:
Department of Emergency Medicine, University of Louisville, School of Medicine, Louisville, Kentucky, USA
Ginger Whitaker
Affiliation:
Department of Mechanical Engineering, University of Louisville, School of Medicine, Louisville, Kentucky, USA
M. Keith Sharp
Affiliation:
Department of Mechanical Engineering, University of Louisville, School of Medicine, Louisville, Kentucky, USA
*
Edmond A. Hooker, MD Department of Health Services Administration, Xavier University, 3800 Victory Parkway Cincinnati, OH 45207-7331, USA E-mail: hookere@xavier.edu
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Abstract

Introduction:

Percutaneous, transtracheal jet ventilation (percutaneous transtracheal jet ventilation) is an effective way to ventilate both adults and children. However, some authors suggest that a resuscitation bag can be utilized to ventilate through a cannula placed into the trachea.

Hypothesis:

Percutaneous transtracheal ventilation (percutaneous transtracheal ventilation) through a 14-gauge catheter is ineffective when attempted using a resuscitation bag.

Methods:

Eight insufflation methods were studied. A 14-gauge intravenous catheter was attached to an adult resuscitation bag, a pediatric resuscitation bag, wall-source (wall) oxygen, portable-tank oxygen with a regulator, and a jet ventilator (JV) at two flow rates. The resuscitation bags were connected to the 14-gauge catheter using a 7 mm adult endotracheal tube adaptor connected to a 3 cc syringe barrel. The wall and tank oxygen were connected to he 14-gauge catheter using a three-way stopcock. The wall oxygen was tested with the regulator set at 15 liters per minute (LPM) and with the regulator wide open. The tank was tested with the regulator set at 15 and 25 LPM. The JV was connected directly to the 14-gauge catheter using JV tubing supplied by the manufacturer. Flow was measured using an Ohmeda 5420 Volume Monitor. A total of 30 measurements were taken, each during four seconds of insufflation, and the results averaged (milliliters (ml) per second (sec)) for each device.

Results:

Flow rates obtained using both resuscitation bags, tank oxygen, and regulated wall oxygen were extremely low (adult 215 ±20 ml/sec; pediatric 195 ±19 ml/sec; tank 358 ±13 ml/sec; wall at 15 l/min 346 ±20 ml/sec). Flow rates of 1,394 ±13 ml were obtained using wall oxygen with the regulator wide open. Using the JV with the regulator set at 50 pounds per square inch (psi), a flow rate of 1,759 ±40 was obtained.These were the only two methods that produced flow rates high enough to provide an adequate tidal volume to an adult.

Conclusions:

Resuscitation bags should not be used to ventilate adult patients through a 14-gauge, transtracheal catheter. Jet ventilation is needed when percutaneous transtracheal ventilation is attempted. If jet ventilation is attempted using oxygen supply tubing, it must be connected to an unregulated oxygen source of at least 50 psi.

Keywords

artificial respirationcatheterizationcricoid cartilageemergency medical serviceshigh-frequency jet ventilationintratracheal intubationresuscitationtracheostomytracheotomy
Type
Original Research
Information
Prehospital and Disaster Medicine , Volume 21 , Issue 6 , December 2006 , pp. 431 - 435
Copyright
Copyright © World Association for Disaster and Emergency Medicine 2006

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