Transtracheal Catheter Ventilation: Clinical Experience in 36 Patients

Abstract

A new method of controlled ventilation in apneic patients, using small catheters inserted percutaneously into the trachea via the cricothyroid membrane, was studied in 36 terminally ill patients. A specially designed 14-gauge catheter was inserted percutaneously into the trachea via the cricothyroid membrane, and attached to standard wall oxygen at 60 lb per-square-inch pressure and 60 liters-per-minute flow. Ventilation was performed either manually or with a specially designed mechanical ventilator. Satisfactory ventilation was achieved in all patients in the presence of an open upper airway. There were no complications attributable to the procedure. The principle of the technique involves intermittent inflation of the lungs during high flow of oxygen. Deflation occurs by spontaneous recoil of the chest and lungs when flow is stopped. Even with a large oral air leak, adequate pressures are achieved through a small catheter. The procedure is simple, and effective controlled ventilation is safely accomplished within fifteen seconds. There is no risk of gastric dilatation with this procedure. The flow of gas up the airway aids in the expulsion of secretions, minimizing the need for suction and preventing pulmonary aspiration.