Transtracheal flow-regulated oxygen insufflation—a simple and safe method for prolonging safe apnoea time in difficult airway management: A report of two cases

Wexler, Sivan; Prineas, Stavros; Suharto, Timothy A

doi:10.1177/0310057x19886868

Cited by 4 publications

(8 citation statements)

References 11 publications

(13 reference statements)

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“…Wexler et al [ 19 ], in a patient with a large base of tongue cancer causing near-complete airway occlusion, applied transtracheal oxygenation using a Rapid-O2 as a bridge to safe transtracheal jet ventilation. As jet ventilation could not be performed on an adult male patient with near-complete airway obstruction due to a large base of tongue cancer, Wexler et al [ 19 ] attempted to remove the mass to some extent while supplying oxygen through Rapid-O2 before creating enough space for applying jet ventilation. In the awake state, a 6-Fr (= ID 2 mm) Cook Transtracheal catheter (Cook Medical) was inserted through the cricothyroid membrane.…”

Section: Rapid-o2 Oxygen Insufflation Device (Rapid-o2)mentioning

confidence: 99%

“…Given that the minute volume is 5–8 L/min, hypercarbia cannot be avoidable. However, instead of waiting for SaO 2 to drop by 93% in Wexler et al’s case [ 19 ] in which it took 6–8 min to drop to 93%, if we adjust inspiration and expiration time in a ratio of 2:10 as described above, hypercarbia may occur in a less severe form. However, it is difficult to maintain this ratio in reality.…”

Section: Rapid-o2 Oxygen Insufflation Device (Rapid-o2)mentioning

confidence: 99%

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Ventilation through a straw

Kim

Park

2022

Anesth Pain Med

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Transtracheal jet ventilation can be used for resuscitation of partial airway obstruction. A prerequisite for jet ventilation is that at least a minimum airway opening for gas escape must be secured. Therefore, another option should be considered in cases of complete airway obstruction. The following methods or devices has been used under cricothyrotomy using an intravenous cannula: 1) Ambu (bag valve mask) bagging, 2) Ventrain®, 3) Rapid-O2 oxygen insufflation device (Rapid-O2), and 4) jet ventilation using a dual lumen catheter. During Ambu bagging, extraordinarily high insufflation pressure is required to force oxygen through the cannula. When using a 12-G cannula, long and slow positive-pressure ventilations (10–12 breaths/min) are required, which makes it extremely difficult to compress the bag. Therefore, a 10-G or larger is recommended. Ventrain® is an expiratory assist device capable of forcibly expelling insufflated oxygen through a transtracheal cannula. It is recommended to adjust the inspiratory and expiratory times while observing the chest wall movements. Rapid-O2 is a rescue oxygenation device with adequate ventilation of less importance; therefore, the resulting hypercarbia is inevitable. A 14-G cannula is used. Lastly, jet ventilation using a dual-lumen catheter with a 16-G inflow lumen and 10-G outflow lumen was used to obtain both oxygenation and ventilation. However, the addition of the outer diameters of 16-G and 10-G results in an outer diameter of 5.1 mm, which is too large to puncture the cricothyroid membrane. In conclusion, Ventrain® is considered the most ideal device for use among the devices developed to date.

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Section: Rapid-o2 Oxygen Insufflation Device (Rapid-o2)mentioning

confidence: 99%

Section: Rapid-o2 Oxygen Insufflation Device (Rapid-o2)mentioning

confidence: 99%

Ventilation through a straw

Kim

Park

2022

Anesth Pain Med

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“…The Rapid-O2™ oxygen insu ation device (Rapid-O2 ® ) is a rescue oxygenation device for use in "cannot intubate, cannot oxygenate" (CICO) events, which consists of a T-connector with an extension tubing attached to a catheter with a Luer lock connector 1,2 . Data from Heard's animal wet lab studies 3 demonstrated that, by extrapolation to humans, 1,000 mL of oxygen was needed for the initial rescue of an adult which equates to 4 s of insu ation at oxygen ow rate of 15 L/min.…”

Section: Introductionmentioning

confidence: 99%

“…An additional 500 mL of oxygen was adequate once the arterial oxygen saturation (SaO 2 ) decreased to 93% after the initial oxygen supply. Percutaneously, a 14 G catheter was used 2,4 . On the basis of this strategy, Wexler et al 2 applied transtracheal oxygenation using Rapid-O2 as a bridge to safe transtracheal jet ventilation in a patient with a large tongue base cancer causing near-total airway occlusion.…”

Section: Introductionmentioning

confidence: 99%

Transcatheter Ventilation with a Modified Rapid-O2 Oxygen Insufflation Device

Jang

Kim

et al. 2023

Preprint

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Rapid-O2™ oxygen insufflation device (Rapid-O2®) has been primarily designed to provide rescue oxygenation; thus, hypercarbia is inevitable. We modified Rapid-O2 to augment ventilation by providing negative pressure during expiration. To determine the most effective combination between the 20 G, 18 G, 16 G, 14 G, or 2-mm internal diameter (ID) transtracheal catheter (TTC) (inner catheters) to create sub-atmospheric pressure and the 16 G, 14 G or 2-mm ID TTC to achieve insufflating flow (insufflating catheters), the corresponding insufflating and expiratory flows and pressures were measured using a gas flow analyzer. Insufflating and expiratory volumes were assessed using a trachea-lung model. Based on the flow measurements of combination between inner and insufflating catheters, the 18 G was chosen as the inner catheter. Insufflating pressures ranged from 97 (2-mm ID TTC) to 377 cmH2O (16 gauge) at oxygen flow rate of 15 L/min. During expiration, negative pressures of ~ 50 cmH2O were measured in three insufflating catheters at 15 L/min. At a lung compliance of 100 mL/cmH2O, with a rate of ~ 12 breathes/min, minute volumes through a 14 G or 2-mm ID TTC were 5.53 and 6.53 L/min, respectively, at 15 L/min. The modified Rapid-O2 could achieve adequate minute ventilation in adults.

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“…There is a scientific body of evidence that hypoxemia can be prevented by deep insufflation of oxygen in the laryngeal space and trachea during apneic episodes [9][10][11][12]. Mitterlechner et al reported that oxygen saturation in a test-lung of a manikin remains significantly higher when using a specific laryngoscope blade designed for laryngeal oxygen insufflation, compared to nasal oxygen insufflation [9].…”

Section: Introductionmentioning

confidence: 99%

Apneic laryngeal oxygenation during elective fiberoptic intubation – a technical simulation

et al. 2020

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Background Sedation during elective fiberoptic intubation for difficult airway can cause respiratory depression, apnea and periods of desaturation. During apneic episodes, hypoxemia can be prevented by insufflation of oxygen in the deep laryngeal space. The aim of this study was to evaluate an oropharyngeal oxygenation device (OOD) designed for deep laryngeal insufflation during fiberoptic intubation. Methods The OOD is split in the front to form a path for the bronchoscope. An external lumen delivers oxygen in the deep laryngeal space. In this experimental study, air application (as control group), oxygen application via nasal prongs, oxygen application via the OOD, and oxygen application via the working channel of a bronchoscope were compared in a technical simulation. In a preoxygenated test lung of a manikin, decrease of the oxygen saturation was measured over 20 min for each method. Results Oxygen saturation in the test lung dropped from 97 ± 1% (baseline in all groups) to 58 ± 3% in the control-group (p < 0.001 compared to all other groups) and to 78 ± 1% in the nasal prong group (p < 0.001 compared to all other groups). Oxygen saturation remained at 95 ± 2% in both the OOD group and the bronchoscopy group (p = 0.451 between those two groups). Conclusion Simulating apneic laryngeal oxygenation in a preoxygenated manikin, both oxygen insufflation via the OOD and the bronchoscope kept oxygen saturation in the test lung at 95% over 20 min. Both methods significantly were more effective than oxygen insufflation via nasal prongs.

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Transtracheal flow-regulated oxygen insufflation—a simple and safe method for prolonging safe apnoea time in difficult airway management: A report of two cases

Cited by 4 publications

References 11 publications

Ventilation through a straw

Ventilation through a straw

Transcatheter Ventilation with a Modified Rapid-O2 Oxygen Insufflation Device

Apneic laryngeal oxygenation during elective fiberoptic intubation – a technical simulation

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