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Chapter 18 - Expiratory Ventilation Assistance and Ventilation through Narrow Tubes

from Section 1 - Airway Management: Background and Techniques

Published online by Cambridge University Press:  03 October 2020

Tim Cook
Affiliation:
Royal United Hospital, Bath, UK
Michael Seltz Kristensen
Affiliation:
Rigshospitalet, Copenhagen University Hospital, Denmark
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Summary

A major challenge of airway management is safe care of the patient with a narrowed airway. Small tracheal tubes offer one solution but pose a problem with ventilation. While inspiration may be achieved by use of a high-pressure source to overcome airway resistance, two problems exist: first, the high-pressure source demands technical excellence and exposes the patient to a high risk of barotrauma; second, conventional (passive) exhalation through a narrow tube is slow and cannot achieve a normal minute ventilation with a tracheal tube of less than 4.5 mm diameter. Recently technical developments have led to the ability to assist expiration and make it, like inspiration, an active process. This technology is used in the Ventrain manual ventilator, the 2.4 mm wide Tritube tracheal tube and the Evone automatic ventilator. These new devices and the applied technology enable solutions for safe management of the narrowed upper airway.

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Publisher: Cambridge University Press
Print publication year: 2020

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References

Further Reading

Berry, M, Tzeng, Y, Marsland, C. (2014). Percutaneous transtracheal ventilation in an obstructed airway model in post-apnoeic sheep. British Journal of Anaesthesia, 113, 10391045.Google Scholar
Cook, TM, Nolan, JP, Cranshaw, J, Magee, P. (2007). Needle cricothyroidotomy. Anaesthesia, 62, 289290.CrossRefGoogle ScholarPubMed
Hamaekers, AE, Borg, PA, Enk, D. (2012). Ventrain: an ejector ventilator for emergency use. British Journal of Anaesthesia, 108, 10171021.Google Scholar
Kristensen, MS, de Wolf, MWP, Rasmussen, LS. (2017). Ventilation via the 2.4 mm internal diameter Tritube® with cuff – new possibilities in airway management. Acta Anaesthesiologica Scandinavica, 61, 580589.Google Scholar
Paxian, M, Preussler, NP, Reinz, T, Schlueter, A, Gottschall, R. (2015). Transtracheal ventilation with a novel ejector-based device (Ventrain) in open, partly obstructed, or totally closed upper airways in pigs. British Journal of Anaesthesia, 115, 308316.Google Scholar
Willemsen, MG, Noppens, R, Mulder, AL, Enk, D. (2014). Ventilation with the Ventrain through a small lumen catheter in the failed paediatric airway: two case reports. British Journal of Anaesthesia, 112, 946947.CrossRefGoogle ScholarPubMed

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