Abstract
The traditional needle cricothyroidotomy procedure is performed blindly without any medical equipment. Complications including posterior tracheal wall perforation, accidental vessel puncture, and missed tracheal puncture are reported. Therefore, we proposed a dual-wavelength fiber-optic technique based on the technique of near-infrared spectroscopy to assist operators performing needle cricothyroidotomy in a swine model. We embedded optical fibers in a 16-gauge intravenous needle catheter. Real-time data were displayed on an oscilloscope, and we used the program to analyze the data immediately. The change of optical density corresponding to 690-nm and 850-nm wavelengths and hemoglobin parameters (HbO2 and Hb concentrations) was analyzed immediately using the program in the laptop. Unique and significant optical differences were presented in this experiment. We could easily identify every different tissue by the change of optical density corresponding to 690-nm and 850-nm wavelengths and hemoglobin parameters (HbO2 and Hb concentrations). Statistical method (Kruskal-Wallis H test) was used to compare differences in tissues at each time-point, respectively. The p values in every tissue in optical density change corresponding to 690 nm and 850 nm were all < 0.001. Furthermore, the p values in every tissue in Hb and HbO2 were also all < 0.001. The results were statistically significant. This is the first and novel study to introduce a dual-wavelength embedded fibers into a standard cricothyroidotomy needle. This proposed system might be helpful to provide us real-time information of the advanced needle tip to decrease possible complications.
Highlights
Management of the difficult airway is usually a challenge, and it is a very important issue for physicians [1]
The fundamental principle of the proposed tracheal recognition system was based on the technique of near-infrared spectroscopy [15,16,17,18,19,20]
Ref., reference category 1 Kruskal-Wallis H test 2 Fixed effect of tissue was examined in a linear mixed model considering repeated measures as a random effect the fundamental principle of near-infrared spectroscopy, this novel optic fiber technique might be helpful for guiding our needle tip into the trachea
Summary
Management of the difficult airway is usually a challenge, and it is a very important issue for physicians [1]. In some emergency situations, inserting an intravenous needle catheter through the cricothyroid membrane is a lifesaving strategy that temporarily provides ventilation in the “cannot intubate, cannot ventilate” scenario [2,3,4,5]. It can provide the patient oxygen for only a temporary period, until a definitive airway is established. It is controversial to choose the inplane or out-of-plane technique when operators perform needle cricothyroidotomy procedure. The proposed system could provide the near-infrared light source emitted from the optic fiber bundles contained within a 16-gauge intravenous needle catheter. With the aid of this technology, we can guide the needle tip into the trachea
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