Jet or intensive care unit ventilator during simulated percutaneous transtracheal ventilation: a lung model study

Area of Science:

• Anesthesiology
• Critical Care Medicine
• Respiratory Physiology

Background:

• Percutaneous transtracheal ventilation (PTV) is a rescue technique for difficult airway management.
• The efficacy of conventional ventilators for PTV is not well-established.
• This study aimed to compare ventilation from conventional and jet ventilators during simulated PTV.

Purpose of the Study:

• To evaluate tidal volume (V(T)) generated by a conventional ventilator during simulated PTV.
• To compare V(T) with that generated by a percutaneous transtracheal jet ventilator (PTJV).
• To assess the impact of catheter insertion direction on V(T) for both ventilator types.

Main Methods:

• A lung model simulating an adult respiratory system was utilized.
• Catheters were inserted into an artificial trachea and connected to either a conventional or a jet ventilator.
• Ventilation parameters were measured with varying catheter orientations (towards, away, perpendicular to the lung) and ventilator settings.

Main Results:

• The jet ventilator produced significantly higher V(T) when the catheter pointed towards the lung (817 ml) compared to other directions.
• Conventional ventilators generated less variable V(T) across different catheter insertion angles (187-229 ml).
• Conventional ventilator V(T) was less dependent on catheter direction than PTJV.

Conclusions:

• PTJV is effective for PTV but requires specific catheter alignment and high pressures.
• Conventional ventilators can achieve reasonable minute ventilation via PTV, with less sensitivity to catheter angulation.
• Conventional ventilators should be considered for emergent PTV in difficult airway scenarios.