[Endoscopic placement of an intratracheal oxygen catheter--description of a new method]

In patients with disturbed gas-exchange intratracheal oxygen insufflation improves oxygenation and reduces the minute ventilation. Until now the intratracheal oxygen insufflation was performed using a tracheostomy or a percutaneous transtracheal technique. We studied the acceptance and efficacy of the intratracheal oxygen insufflation using a bronchoscopic technique of intratracheal catheter placement.

Five COPD-patients (4 men, 55.2 +/- 10.3 years; FEV1: 0.9 +/- 0.31 = 30.3 +/- 5.5% debit, pO2: 56.2 +/- 10.3 mmHg, pCO2 +/- 43.1 +/- 4.8 mmHg). Procedure of catheter placement: Through a nasally passed bronchoscope a guide wire was inserted into the proximal part of one bronchus. When positioned at the point 2 to 3 cm proximal to the carina, the bronchoscope was marked with plaster at the nasal ostium in order to measure this distance. After removing the endoscope, the oxygen catheter was inserted proximal to the carina using the guide wire. Before and during the intratracheal oxygen insufflation (flow: 3 l/min) minute ventilation, tidal volume, breathing frequence, blood gases and the subjective scores (using a visual analogue scale) were measured.

Apart from one patient with a tolerable spontaneous declining urge to cough irritation the catheter was tolerated well during the study. Whereas pCO2 remained stable during the ITO2 (before ITO2: 43.1 +/- 4.8 mmHg; after 1 hour ITO2: 44.3 +/- 4.8 mmHg), the oxygenation improved (pO2: 56.2 +/- 10.3; 81.4 +/- 19.6 mmHg) and the minute ventilation decreased (7.5 +/- 1.8; 5.4 +/- 1.3 l/min) by approximately 28%.

The bronchoscopic application of the intratracheal oxygen catheter was characterized by high acceptance, low invasiveness and immediate function. Furthermore, the minute ventilation and work of breathing respectively decreased to a relevant degree.