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• W2028111997 abstract "The online video in the May issue of AEM, by Beck et al.,1 perpetuates a series of interrelated myths about percutaneous transtracheal jet ventilation that make the technique appear more difficult to perform and less useful than it actually is. The authors correctly note that complete airway obstruction is an absolute contraindication, but this is only true if the block is bidirectional; i.e., it blocks exhalation as well as inhalation. They then recommend a large-bore catheter and an intermittent flow of oxygen, as do many other secondary sources. They demonstrate the technique using a complex pressure valve system, which is unlikely to be immediately available when one is faced with an apneic and unventilatable patient. There is no need to do this. Our technique2 in an adult is to: Insert an 18-gauge catheter through the cricoid membrane. We generally aim toward the head since this is easier, particularly in men, and makes subsequent retrograde intubation over a guide wire simpler. This should be adequate unless the obstruction is very low, although the needle must be removed from the catheter before it reaches the vocal cords to avoid injury. The catheter is then connected to a 3 or 5 mL syringe, retested for placement and the syringe plunger removed. The catheter and syringe are held in place manually, being careful to avoid dislodging the catheter and causing subcutaneous emphysema. A length of oxygen extension tubing is connected to wall or bottled oxygen and held firmly in the open syringe. The oxygen flow rate is turned to 15 L/min. There is no reason to interrupt the flow of oxygen at this point. An assistant obstructs the upper airway with a mask or hand until the chest rises and then removes the obstruction to allow for normal exhalation. Fifteen L/min approximates the normal respiratory demand (0.2 l/kg/min) for a 70-kg adult. This is adequate for long-term ventilatory support. The reader can easily prove this by assembling the device and using it as his or her own air source. A 20-gauge catheter is actually adequate, but an 18-gauge is stiffer and easier to hold in place. The large-bore catheter/intermittent technique was apparently developed to ventilate patients with a complete airway obstruction and provides for exhalation via the catheter itself. These patients are fortunately rare, and our technique is appropriate for the large majority of patients." @default.
• W2028111997 created "2016-06-24" @default.
• W2028111997 creator A5058953813 @default.
• W2028111997 date "2011-09-26" @default.
• W2028111997 modified "2023-10-14" @default.
• W2028111997 title "Percutaneous Transtracheal Jet Ventilation" @default.
• W2028111997 cites W1972900046 @default.
• W2028111997 cites W2740671503 @default.
• W2028111997 doi "https://doi.org/10.1111/j.1553-2712.2011.01180.x" @default.
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