Assessment of continuous ventilation during tracheal dilatation using a novel, non-occlusive balloon in an ovine model

Abstract

Introduction: Balloon dilatation is frequently used in the management of tracheal stenosis. Traditional dilatation balloons cause complete occlusion of the tracheal lumen when deployed, limiting duration of dilatation due to development of hypoxia and increasing the risk of barotrauma. We assessed a novel, non occlusive airway dilatation balloon to determine whether it would allow continuous oxygenation and ventilation. Methods: This was a prospective, descriptive, interventional trial undertaken in the animal research laboratory using a healthy ovine model. Eight anaesthetised adult Dohne Merino sheep underwent placement and inflation of the study device in the trachea via an endotracheal tube with multiport adaptor. Airway pressures, ventilatory parameters, end-tidal capnography and peripheral oxygen saturations were monitored continuously and measured before insertion, before inflation and during balloon inflation. Results: All subjects could be ventilated continuously. At no time during balloon deployment and inflation was there a loss of capnograph waveform or peripheral arterial desaturation. While there was a slight trend to increased pressures and decreased tidal volumes after balloon insertion and inflation, these changes were not clinically relevant. The median (range) at each time point were tidal volume of 565 (370–780), 560 (330–830) and 550 (320–830) ml, peak airway pressure of 11(9–22), 14 (11–17) and 14 (13–17) cmH2O, and plateau pressure of 9 (7–17), 11 (9–14) and 11 (9–14) cmH2O respectively. Conclusion: Continuous oxygenation and ventilation through the study device during tracheal dilatation is possible, effective and practical.