Ventilation through a small-bore catheter: optimizing expiratory ventilation assistance.

Autor: Hamaekers AE; Department of Anaesthesia, Maastricht University Medical Centre, PO Box 5800, 6202 AZ Maastricht, The Netherlands. a.hamaekers@mumc.nl, Borg PA, Götz T, Enk D
Jazyk: angličtina
Zdroj: British journal of anaesthesia [Br J Anaesth] 2011 Mar; Vol. 106 (3), pp. 403-9. Date of Electronic Publication: 2010 Dec 22.
DOI: 10.1093/bja/aeq364
Abstrakt: Background: Emergency ventilation through a small-bore transtracheal catheter can be lifesaving in a 'cannot intubate, cannot ventilate' situation. Ejectors, capable of creating suction by the Bernoulli principle, have been proposed to facilitate expiration through small-bore catheters. In this bench study, we compared a novel, purpose-built ventilation ejector (DE 5) with a previously proposed, modified industrial ejector (SBP 07).
Methods: The generated insufflation pressures, suction pressures in static and dynamic situations, and also suction capacities and entrainment ratios of the SBP 07 and the DE 5 were determined. The DE 5 was also tested in a lung simulator with a simulated complete upper airway obstruction. Inspiratory and expiratory times through a transtracheal catheter were measured at various flow rates and achievable minute volumes were calculated.
Results: In a static situation, the SBP 07 showed a more negative pressure build-up compared with the DE 5. However, in a dynamic situation, the DE 5 generated a more negative pressure, resulting in a higher suction capacity. Employment of the DE 5 at a flow rate of 18 litre min(-1) allowed a minute volume through the transtracheal catheter of up to 8.27 litre min(-1) at a compliance of 100 ml cm H(2)O(-1). The efficiency of the DE 5 depended on the flow rate of the driving gas and the compliance of the lung simulator.
Conclusion: In laboratory tests, the DE 5 is an optimized ventilation ejector suitable for applying expiratory ventilation assistance. Further research may confirm the clinical applicability as a portable emergency ventilator for use with small-bore catheters.
Databáze: MEDLINE