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• W4248535714 abstract "Editor'We thank Drs Waddilove and Kessell for their comments on our study.1Hamaekers AEW Borg PAJ Gotz T Enk D Ventilation through a small-bore catheter: optimizing expiratory ventilation assistance.Br J Anaesth. 2011; 106: 403-409Abstract Full Text Full Text PDF PubMed Scopus (24) Google Scholar The letter published by Kessell in 19992Kessell G Transtracheal jet ventilation and the completely obstructed airway: incorporating an active expiratory phase.J Accid Emerg Med. 1999; 16: 390Crossref PubMed Google Scholar confirms some of our findings: in a completely obstructed upper airway, insertion of a second small-bore cannula for expiration is senseless if used for passive backflow, and suction can efficiently aid expiration. We wholeheartedly agree with the statement by Kessell that an active expiratory phase may help, by adequate minute volume ventilation, to bridge the time until a definitive airway can be established. Several devices providing expiratory assistance have been published since introduction of the concept by Eger and Hamilton3Eger EI Hamilton WK Positive–negative pressure ventilation with a modified Ayre's T-piece.Anesthesiology. 1958; 19: 611-618Crossref PubMed Scopus (9) Google Scholar in 1958. In his letter, Kessell describes a simple system with a Sanders injector and suction tubing both connected to a transtracheal cannula by a three-way stopcock. This actually resembles a more sophisticated setup intended for small lumen ventilation introduced by Schapera and colleagues4Schapera A Bainton CR Kraemer R Lee K A pressurized injection/suction system for ventilation in the presence of complete airway obstruction.Crit Care Med. 1994; 22: 326-333Crossref PubMed Scopus (13) Google Scholar in 1994. They also proposed separate oxygen and suction tubing with injection and suction pressures and also inspiration and expiration times controlled by a computer. In a can't intubate, can't ventilate situation, time is limited and, preferably, any device to be used should be readily available, easy, and, of course, safe to use. In the case of upper airway obstruction, a flow-regulated device (such as the DE 5) is safer compared with a pressure-regulated tool (such as a Sanders injector) because the injected volume of oxygen can easily be estimated. The use of a Sanders injector driven by wall pressure results in injection of highly compressed oxygen which will expand in the patient's lungs. The minute volume achievable with the self-assembled system proposed by Kessell might be higher compared with the DE 5, but at the price of using wall pressure (up to 5 bar) for inspiration and maximum suction pressure (up to −0.8 bar). Actually, for safety reasons, the DE 5 was designed to allow an adequate minute volume at much lower injection and suction pressures (typically below 0.15 bar injection and −0.4 bar suction pressure). The research done in the manuscript was supported by funding from the European Union, OP-Zuid [31R104]. D.E. is the inventor of the Oxygen Flow Modulator (OFM) and receives royalty payments from Cook Medical. D.E. has applied for a patent on the DE 5." @default.
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• W4248535714 date "2011-06-01" @default.
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• W4248535714 title "Reply from the authors" @default.
• W4248535714 doi "https://doi.org/10.1093/bja/aer136" @default.
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