Ventrain: from theory to practice. Bridging until re-tracheostomy

Area of Science:

• Critical Care Medicine
• Respiratory Physiology
• Anesthesiology

Background:

• Life-threatening upper airway obstruction from tracheal stenosis presents significant management challenges.
• Tracheal stenosis, particularly in patients with prior tracheostomy, requires advanced ventilation strategies.

Observation:

• A 77-year-old female with a history of tracheostomy presented with critical tracheal stenosis.
• Standard intubation failed; ventilation was initiated using Ventrain via a tube exchanger.
• Ventrain provides active expiration through suction, supplementing oxygenation during inspiration.

Findings:

• The patient was adequately ventilated with permissive hypercapnia (50 mm Hg) and high oxygen saturation (95%-98%) despite near-complete airway obstruction.
• Hemodynamic stability was maintained, suggesting prevention of air trapping and barotrauma.

Implications:

• Ventrain's active expiration mechanism may be crucial in preventing intrapulmonary pressure increase and hemodynamic compromise in severe airway obstruction.
• This case highlights Ventrain as a viable alternative to traditional ventilation methods in critical airway scenarios.
• Further research into Ventrain's efficacy in complete airway obstruction is warranted.