The Efficacy of Spontaneous and Controlled Ventilation With Various Cricothyrotomy Devices: A Quantitative In Vitro Assessment in a Model Lung

Abstract

As expected, cuffed cricothyrotomy devices yield the best results during controlled, manual, and spontaneous ventilation. With uncuffed cricothyrotomy devices, ventilation becomes ineffective when the upper airway obstruction allows for an upper airway diameter>3 mm.

Impaired Ventilation and Oxygenation After Emergency Cricothyrotomy

“…Michalek-Sauberer and colleagues used a model lung to assess respiratory mechanics during ventilation with seven cricothyrotomy devices at varying levels of compliance and resistance. (5) They concluded that the Quicktrach II , like other cuffed devices with an internal diameter of at least 4.0 mm, provided adequate tidal volumes during controlled ventilation at physiologic airway pressures regardless of model lung compliance or resistance. In a simulated human lung model with arterial oxygen saturation of 80%, Vadodaria and colleagues found that an uncuffed Quicktrach I device could be placed by an anesthetist in a median time of 51 seconds and allowed for attainment of a PaO 2 > 100 mmHg in 58 seconds.…”

Elective use of an uncuffed small-bore cricothyrotomy tube with balloon occlusion of the subglottic airway

“…Effective ventilation was defined as a tidal volume of C 300 mL delivered by volume control ventilation in an ordinary setting with normal lung compliance and airway resistance. 7 Reportedly, uncuffed devices, including a 6-mm ID Melker Ò , yielded ineffective ventilation in the presence of a large leak, whereas, not surprisingly, every cuffed device produced satisfactory results irrespective of the amount of leak. The uncuffed 4-mm ID Quicktrach Ò I was acceptable for controlled ventilation with little to no leakage, allowing spontaneous ventilation without excessive negative inspiratory pressure even with complete obstruction.…”

“…Previous model lung studies showed that uncuffed smallbore devices with open upper airways yielded ineffective ventilation, whereas acceptable ventilation can be achieved by occlusion of the upper airway. [5][6][7] Thus, the purpose of this study was to examine the feasibility of controlled ventilation for cricothyrotomy via an uncuffed small-bore tube, together with an orally or nasally inserted subglottic balloon to minimize supraglottic leak.…”

Vergleich von Fertigsets zur Koniotomie

“…der Größe eines in dieser Situation häufig verwendeten Endotrachealtubus. Das sichert nicht nur ausreichende Tidal-und Minutenvolumina [5,12], sondern ermöglicht auch andere notfallrelevante Maßnahmen wie das endotracheale Absaugen. Eine Ruptur der Kanülen-Cuffs wurde weder in dieser Serie noch in anderen beobachtet [11].…”

“…AF Airfree, PCK Portex-Crico-Kit, QTI Quicktrach I, QTII Quicktrach II, Sk. Skalpell, TQ TracheoQuick, VVK periphere Venenverweilkanüle chalek-Sauberer et al[12] weisen ebenfalls darauf hin, dass ungeblockte Kanülen erst eine ausreichende Ventilation bei einem oberen Atemwegslumen <3 mm ermögli-chen. Dies kann durch einen zusätzlichen Verschluss von Mund und Nase (z.…”